Provider Demographics
NPI:1912609744
Name:FAMILY MEDICINE INSTITUTE PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:FAMILY MEDICINE INSTITUTE PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YASHEL
Authorized Official - Middle Name:WEDDERBURN
Authorized Official - Last Name:LANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-459-4360
Mailing Address - Street 1:15126 SHONAN GOLD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5684
Mailing Address - Country:US
Mailing Address - Phone:718-924-1316
Mailing Address - Fax:
Practice Address - Street 1:15126 SHONAN GOLD DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5684
Practice Address - Country:US
Practice Address - Phone:718-924-1316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-17
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty