Provider Demographics
NPI:1659002186
Name:VELEZ FADUL, YESLINEL (MD)
Entity type:Individual
Prefix:
First Name:YESLINEL
Middle Name:
Last Name:VELEZ FADUL
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 1:943 NICKLAUS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-9334
Mailing Address - Country:US
Mailing Address - Phone:787-430-4441
Mailing Address - Fax:
Practice Address - Street 1:501 OLDE WATERFORD WAY
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4117
Practice Address - Country:US
Practice Address - Phone:910-408-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-02545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine