Provider Demographics
NPI:1275828964
Name:PARDO, YOBANY FERNANDO (PHD)
Entity Type:Individual
Prefix:
First Name:YOBANY
Middle Name:FERNANDO
Last Name:PARDO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8608 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:GOODELLS
Mailing Address - State:MI
Mailing Address - Zip Code:48027-1303
Mailing Address - Country:US
Mailing Address - Phone:810-223-1453
Mailing Address - Fax:
Practice Address - Street 1:221 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2653
Practice Address - Country:US
Practice Address - Phone:248-398-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical