Provider Demographics
NPI:1801360821
Name:SEJOUR, YAMINAH (NURSE)
Entity Type:Individual
Prefix:MS
First Name:YAMINAH
Middle Name:
Last Name:SEJOUR
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12941 NW 2ND ST APT 109
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2233
Mailing Address - Country:US
Mailing Address - Phone:305-244-1031
Mailing Address - Fax:
Practice Address - Street 1:551 NW 135TH AVE APT 101
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2246
Practice Address - Country:US
Practice Address - Phone:305-244-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5228970251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1801360821Medicaid