Provider Demographics
NPI:1841266061
Name:YASIN, ALIYA (MD)
Entity type:Individual
Prefix:
First Name:ALIYA
Middle Name:
Last Name:YASIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2676 US HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6191
Mailing Address - Country:US
Mailing Address - Phone:904-797-2121
Mailing Address - Fax:904-797-2120
Practice Address - Street 1:2676 US HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6191
Practice Address - Country:US
Practice Address - Phone:904-797-2121
Practice Address - Fax:904-797-2120
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME873092080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267081000Medicaid