Provider Demographics
NPI:1457098907
Name:CEBALLO HIDALGO, YUNAISY
Entity Type:Individual
Prefix:
First Name:YUNAISY
Middle Name:
Last Name:CEBALLO HIDALGO
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 1:496 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-3385
Mailing Address - Country:US
Mailing Address - Phone:502-654-3685
Mailing Address - Fax:
Practice Address - Street 1:5307 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2536
Practice Address - Country:US
Practice Address - Phone:305-278-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1546208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice