Provider Demographics
NPI:1952644957
Name:RODDENBERRY, YANA AZBUKINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:YANA
Middle Name:AZBUKINA
Last Name:RODDENBERRY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:YANA
Other - Middle Name:AZBUKINA
Other - Last Name:GUERIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:9570 SW 107TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2791
Mailing Address - Country:US
Mailing Address - Phone:305-271-1564
Mailing Address - Fax:
Practice Address - Street 1:9570 SW 107TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2791
Practice Address - Country:US
Practice Address - Phone:305-271-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3839213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery