Provider Demographics
NPI:1831482637
Name:BELLO, YIDA M (MA 54498)
Entity Type:Individual
Prefix:
First Name:YIDA
Middle Name:M
Last Name:BELLO
Suffix:
Gender:F
Credentials:MA 54498
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1850 FOREST HILL BLVD
Mailing Address - Street 2:102
Mailing Address - City:LAKE CLARKE SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6064
Mailing Address - Country:US
Mailing Address - Phone:561-249-0764
Mailing Address - Fax:561-304-4404
Practice Address - Street 1:1850 FOREST HILL BLVD
Practice Address - Street 2:102
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-6064
Practice Address - Country:US
Practice Address - Phone:561-249-0764
Practice Address - Fax:561-304-4404
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54498172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist