Provider Demographics
NPI:1629446802
Name:MANCHESTER, YUN SUK
Entity Type:Individual
Prefix:MS
First Name:YUN SUK
Middle Name:
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:MANCHESTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19165 SW 105TH LANE RD
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-4417
Mailing Address - Country:US
Mailing Address - Phone:352-369-7872
Mailing Address - Fax:
Practice Address - Street 1:1539 NE 22ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4761
Practice Address - Country:US
Practice Address - Phone:352-369-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator