Provider Demographics
NPI:1447554886
Name:LANDA-COLON, YANETSI (MD)
Entity type:Individual
Prefix:
First Name:YANETSI
Middle Name:
Last Name:LANDA-COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 GALT OCEAN DR PH H
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6137
Mailing Address - Country:US
Mailing Address - Phone:908-377-9607
Mailing Address - Fax:
Practice Address - Street 1:512 NE 13TH ST STE B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1168
Practice Address - Country:US
Practice Address - Phone:908-377-9607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109464208000000X, 207PP0204X
FL109464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003616900Medicaid