Provider Demographics
NPI:1356413835
Name:YANELLI, EMMANUEL A (DO)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:A
Last Name:YANELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 SANDY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8601
Mailing Address - Country:US
Mailing Address - Phone:330-297-9956
Mailing Address - Fax:
Practice Address - Street 1:6847 N CHESTNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-296-9606
Practice Address - Fax:330-297-9835
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430202Medicaid
OHYA7315421Medicare ID - Type Unspecified
OH2430202Medicaid