Provider Demographics
NPI:1396728770
Name:YANKASKAS, MARY C (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:YANKASKAS
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 1:12730 NEW BRITTANY BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4690
Mailing Address - Country:US
Mailing Address - Phone:239-275-5522
Mailing Address - Fax:239-275-4464
Practice Address - Street 1:12730 NEW BRITTANY BLVD STE 602
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4690
Practice Address - Country:US
Practice Address - Phone:239-275-5522
Practice Address - Fax:239-275-4464
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61723207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000011209MOtherHUMANA
FL16140OtherSTAYWELL
FL14762OtherBC/BS OF FLORIDA
FL058381200Medicaid
FL058381200Medicaid
FL16140OtherSTAYWELL