Active NPI
Fady Samah Samy Yassa
- Pharmacist
- Fort Myers, FL
National Provider Identifier
1194382036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS54714
- Practice address
- 4204 Palm Beach Blvd
Fort Myers, FL 33905-3413 - Phone
- (239) 694-2114
- NPI assigned
- May 27, 2019
- Last updated
- Mar 11, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS54714 | FL | Primary |
Addresses
Primary practice location
4204 Palm Beach Blvd
Fort Myers, FL 33905-3413
Mailing address
4204 Palm Beach Blvd
Fort Myers, FL 33905-3413
Phone (239) 694-2114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS54714 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1194382036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4204 PALM BEACH BLVD",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339053413",
"telephone_number": "239-694-2114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4204 PALM BEACH BLVD",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339053413",
"telephone_number": "239-694-2114"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YASSA",
"first_name": "FADY",
"middle_name": "SAMAH SAMY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-27",
"last_updated": "2021-03-11",
"certification_date": "2021-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS54714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.