Provider Demographics
NPI:1104922053
Name:NYANUDOR, VAVA YAO (MD)
Entity type:Individual
Prefix:DR
First Name:VAVA
Middle Name:YAO
Last Name:NYANUDOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9173 TREESIDE CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-4340
Mailing Address - Country:US
Mailing Address - Phone:239-348-8096
Mailing Address - Fax:
Practice Address - Street 1:5262 GOLDEN GATE PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7670
Practice Address - Country:US
Practice Address - Phone:239-353-4101
Practice Address - Fax:239-353-4231
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255442900Medicaid
FLG84484Medicare UPIN
FL44577ZMedicare ID - Type Unspecified