Provider Demographics
NPI:1821586546
Name:LOPEZ-YIANILOS, ANDREA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:LOPEZ-YIANILOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13625 SW 82ND CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1010
Mailing Address - Country:US
Mailing Address - Phone:305-890-4771
Mailing Address - Fax:
Practice Address - Street 1:115 W 30TH ST RM 709
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4068
Practice Address - Country:US
Practice Address - Phone:646-397-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022934103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical