Provider Demographics
NPI:1851740799
Name:YUNEZ, NICHOLAS SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SAMUEL
Last Name:YUNEZ
Suffix:
Gender:M
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:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-0884
Mailing Address - Country:US
Mailing Address - Phone:321-766-4572
Mailing Address - Fax:888-505-6685
Practice Address - Street 1:7345 W SAND LAKE RD STE 206
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5280
Practice Address - Country:US
Practice Address - Phone:140-797-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine