Provider Demographics
NPI:1689217853
Name:MURSULI, YANNY
Entity Type:Individual
Prefix:
First Name:YANNY
Middle Name:
Last Name:MURSULI
Suffix:
Gender:F
Credentials:
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 440561
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-0561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3785 NW 82ND AVE STE 408
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6632
Practice Address - Country:US
Practice Address - Phone:786-580-4784
Practice Address - Fax:305-675-9244
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy