Basic Information
| Provider Information | |||||||||
| NPI: | 1134361280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEIL | ||||||||
| FirstName: | GIANNI | ||||||||
| MiddleName: | YANIQUE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413577950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3460 N ANDREWS AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333096060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549473227 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2009 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME116159 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 282035901 | 05 | TX | MEDICAID |