Provider Demographics
NPI:1205281151
Name:PONS DURAN, YAMELYS
Entity type:Individual
Prefix:
First Name:YAMELYS
Middle Name:
Last Name:PONS DURAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20197 NAVAJO LN
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-4047
Mailing Address - Country:US
Mailing Address - Phone:941-735-8404
Mailing Address - Fax:
Practice Address - Street 1:20197 NAVAJO LN
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-4047
Practice Address - Country:US
Practice Address - Phone:941-735-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1205281151Medicaid