Provider Demographics
NPI:1205080074
Name:DAVID A YUDELL, PSY.D., P.A.
Entity type:Organization
Organization Name:DAVID A YUDELL, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:YUDELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-801-7996
Mailing Address - Street 1:5489 WILES RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4220
Mailing Address - Country:US
Mailing Address - Phone:954-801-7996
Mailing Address - Fax:954-333-3573
Practice Address - Street 1:5489 WILES RD
Practice Address - Street 2:SUITE 305
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4220
Practice Address - Country:US
Practice Address - Phone:954-801-7996
Practice Address - Fax:954-333-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7134103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL769006100Medicaid