Healthcare Provider Details

I. General information

NPI: 1902425127
Provider Name (Legal Business Name): ANASTASIYA PHILIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W YAMATO RD STE A4
BOCA RATON FL
33431-4428
US

IV. Provider business mailing address

1200 W YAMATO RD STE A4
BOCA RATON FL
33431-4428
US

V. Phone/Fax

Practice location:
  • Phone: 561-475-2866
  • Fax:
Mailing address:
  • Phone: 561-475-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number062112
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: