Provider Demographics
NPI:1386602381
Name:BERRYER, YVANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:YVANNE
Middle Name:M
Last Name:BERRYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4720
Mailing Address - Country:US
Mailing Address - Phone:305-247-2475
Mailing Address - Fax:305-357-2499
Practice Address - Street 1:829 NE 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030
Practice Address - Country:US
Practice Address - Phone:305-247-2475
Practice Address - Fax:305-357-2499
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0063507174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251422200Medicaid
FL186304Medicare ID - Type Unspecified
FL251422200Medicaid