Provider Demographics
NPI:1285318683
Name:SMITH FONDIN, YUANNYS I
Entity type:Individual
Prefix:
First Name:YUANNYS
Middle Name:
Last Name:SMITH FONDIN
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 SW 10TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4355
Mailing Address - Country:US
Mailing Address - Phone:786-779-9601
Mailing Address - Fax:
Practice Address - Street 1:3500 SW 10TH ST APT 1B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4355
Practice Address - Country:US
Practice Address - Phone:786-779-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-148458247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other