Individual
YELDA N WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3825 HENDERSON BLVD STE 406, TAMPA, FL 33629-5022
(813) 291-7150
(855) 318-5403
Mailing address
1734 NEVADA AVE NE, SAINT PETERSBURG, FL 33703-3344
(703) 981-7069
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY11975
FL
103G00000X
Clinical Neuropsychologist
Primary
YP11975
—
Other
Enumeration date
05/03/2021
Last updated
03/16/2026
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