Provider Demographics
NPI:1063695740
Name:YACHT HAVEN FAMILY PRACTICE
Entity type:Organization
Organization Name:YACHT HAVEN FAMILY PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-775-2303
Mailing Address - Street 1:6500 RED HOOK PLZ
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-1306
Mailing Address - Country:US
Mailing Address - Phone:340-775-2303
Mailing Address - Fax:340-779-2077
Practice Address - Street 1:5302 YACHT HAVEN GRANDE
Practice Address - Street 2:BOX 48
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-5004
Practice Address - Country:US
Practice Address - Phone:340-776-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIHT602AMedicare PIN