Provider Demographics
NPI:1679607592
Name:DANIELS, YELANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:YELANDRA
Middle Name:
Last Name:DANIELS
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:PO BOX 640573
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-0573
Mailing Address - Country:US
Mailing Address - Phone:352-489-2486
Mailing Address - Fax:912-739-5001
Practice Address - Street 1:756 N SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-9072
Practice Address - Country:US
Practice Address - Phone:352-341-5520
Practice Address - Fax:352-489-5786
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66015207Q00000X
FLME147554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111182AMedicaid
OH0968127Medicaid
OHMA0695817Medicare PIN