Provider Demographics
NPI:1700050275
Name:DENO, YOHANNA (MD)
Entity Type:Individual
Prefix:
First Name:YOHANNA
Middle Name:
Last Name:DENO
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 1:1430 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2134
Mailing Address - Country:US
Mailing Address - Phone:772-877-9591
Mailing Address - Fax:561-623-0613
Practice Address - Street 1:1430 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:STE 101
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2134
Practice Address - Country:US
Practice Address - Phone:772-877-9591
Practice Address - Fax:561-623-0613
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H0513WMedicare PIN