Individual
IVELISSE YADIRA CANCEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
259 BILL FRANCE BLVD, SUITE 200, DAYTONA BEACH, FL 32114-1316
(484) 885-9335
Mailing address
77 BUTTERFIELD DR, PALM COAST, FL 32137-3517
(484) 885-9335
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/11/2012
Last updated
11/12/2012
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