Healthcare Provider Details

I. General information

NPI: 1942335492
Provider Name (Legal Business Name): ANETA DADASHEVA PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 01/14/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 GRIFFIN RD
FORT LAUDERDALE FL
33312-5648
US

IV. Provider business mailing address

2950 GRIFFIN RD
FORT LAUDERDALE FL
33312-5648
US

V. Phone/Fax

Practice location:
  • Phone: 954-924-6151
  • Fax: 954-924-1540
Mailing address:
  • Phone: 954-924-6151
  • Fax: 954-924-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011476
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: