Healthcare Provider Details

I. General information

NPI: 1730433483
Provider Name (Legal Business Name): YAEL EVA KUSHNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YAEL EVA ASSIDON PA-C

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2699 STIRLING RD STE B305
FT LAUDERDALE FL
33312-6546
US

IV. Provider business mailing address

2699 STIRLING RD STE B100
FT LAUDERDALE FL
33312-6543
US

V. Phone/Fax

Practice location:
  • Phone: 954-981-9180
  • Fax: 954-961-4752
Mailing address:
  • Phone: 305-223-8808
  • Fax: 954-962-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberPA9106870
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: