Provider Demographics
NPI:1528120219
Name:YANIQUE DUVAL MD PA
Entity type:Organization
Organization Name:YANIQUE DUVAL MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YANIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-687-1304
Mailing Address - Street 1:518 SW PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT-ST-LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-0000
Mailing Address - Country:US
Mailing Address - Phone:772-344-2293
Mailing Address - Fax:772-344-2253
Practice Address - Street 1:518 SW PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT-ST-LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-0000
Practice Address - Country:US
Practice Address - Phone:772-344-2293
Practice Address - Fax:772-344-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME925872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273843100Medicaid
FL273843100Medicaid