Provider Demographics
NPI:1699466243
Name:MEDEROS, YANI A
Entity type:Individual
Prefix:MISS
First Name:YANI
Middle Name:A
Last Name:MEDEROS
Suffix:
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 1:17400 SW 267TH LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-2336
Mailing Address - Country:US
Mailing Address - Phone:305-910-5057
Mailing Address - Fax:
Practice Address - Street 1:17400 SW 267TH LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33031-2336
Practice Address - Country:US
Practice Address - Phone:305-910-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician