Provider Demographics
NPI:1053185090
Name:PABON, YAMINELLIE
Entity type:Individual
Prefix:
First Name:YAMINELLIE
Middle Name:
Last Name:PABON
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 1:3555 PROMENADE PL APT 225
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-7234
Mailing Address - Country:US
Mailing Address - Phone:321-594-3789
Mailing Address - Fax:
Practice Address - Street 1:3555 PROMENADE PL APT 225
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-7234
Practice Address - Country:US
Practice Address - Phone:321-594-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician