Provider Demographics
NPI:1124117478
Name:YUDELL, DAVID A (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:YUDELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5489 WILES RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4220
Mailing Address - Country:US
Mailing Address - Phone:954-801-7996
Mailing Address - Fax:954-333-3573
Practice Address - Street 1:5489 WILES RD
Practice Address - Street 2:SUITE 305
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4220
Practice Address - Country:US
Practice Address - Phone:954-801-7996
Practice Address - Fax:954-333-3573
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7134103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical