Provider Demographics
NPI:1013448562
Name:FATTAH, YASMIN HAMBAROUSH (MD)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:HAMBAROUSH
Last Name:FATTAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YASMIN
Other - Middle Name:
Other - Last Name:HAMBAROUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3272 MALONE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1236
Mailing Address - Country:US
Mailing Address - Phone:203-500-6657
Mailing Address - Fax:
Practice Address - Street 1:16250 NW 59TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7542
Practice Address - Country:US
Practice Address - Phone:203-500-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4417207ZP0102X
FL34652207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology