Provider Demographics
NPI:1851010714
Name:SASAKI, YANA (IMH)
Entity Type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:SASAKI
Suffix:
Gender:F
Credentials:IMH
Other - Prefix:
Other - First Name:YANA
Other - Middle Name:
Other - Last Name:SASAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMH
Mailing Address - Street 1:660 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-4607
Mailing Address - Country:US
Mailing Address - Phone:561-619-5858
Mailing Address - Fax:561-423-8228
Practice Address - Street 1:720 S DIXIE HWY STE 3
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-4652
Practice Address - Country:US
Practice Address - Phone:616-195-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20470101YM0800X
FLMH21511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty