Provider Demographics
NPI:1629033840
Name:YASMIN, SURAIYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SURAIYA
Middle Name:
Last Name:YASMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7420 COMMUNITY COURT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-869-8216
Mailing Address - Fax:727-869-8122
Practice Address - Street 1:7420 COMMUNITY COURT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-869-8216
Practice Address - Fax:727-869-8122
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
05543OtherUNIVERSAL
14473OtherALL FLORIDA PPO
224605OtherAMERIGROUP
FL263712000Medicaid
188549OtherWELLCARE
0404420OtherUNITED HEALTHCARE
282542OtherAVMED
05543OtherUNIVERSAL
14473OtherALL FLORIDA PPO