Provider Demographics
NPI:1689822025
Name:BENDROSS, YANEH SIMON
Entity type:Individual
Prefix:
First Name:YANEH
Middle Name:SIMON
Last Name:BENDROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YANEH
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3616 HARDEN BLVD # 128
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5938
Mailing Address - Country:US
Mailing Address - Phone:137-867-6178
Mailing Address - Fax:
Practice Address - Street 1:3828 MCELVEEN AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-4160
Practice Address - Country:US
Practice Address - Phone:813-764-8129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13072225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist