Provider Demographics
NPI:1154878379
Name:HERNANDEZ, YUDESKY (DDS)
Entity type:Individual
Prefix:
First Name:YUDESKY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NW 57TH AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2054
Mailing Address - Country:US
Mailing Address - Phone:786-768-9017
Mailing Address - Fax:
Practice Address - Street 1:815 NW 57TH AVE STE 325
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2054
Practice Address - Country:US
Practice Address - Phone:786-768-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110948700Medicaid