Provider Demographics
NPI:1952366619
Name:YANDEL, STEPHEN H (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:YANDEL
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 1:845 CENTURY MEDICAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2157
Mailing Address - Country:US
Mailing Address - Phone:321-529-6202
Mailing Address - Fax:321-802-6864
Practice Address - Street 1:845 CENTURY MEDICAL DR STE B
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2157
Practice Address - Country:US
Practice Address - Phone:321-529-6202
Practice Address - Fax:321-802-6864
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102208569207RH0000X
OH34.016906207RH0003X
FLOS5909207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
830002523OtherRAIL ROAD MEDICARE
FL250501100Medicaid
830002523OtherRAIL ROAD MEDICARE
FLIT794ZMedicare PIN