Healthcare Provider Details

I. General information

NPI: 1205101862
Provider Name (Legal Business Name): ALEXANDER PUSHKA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7369 SHERIDAN ST STE 203
HOLLYWOOD FL
33024-2776
US

IV. Provider business mailing address

7369 SHERIDAN ST STE 203
HOLLYWOOD FL
33024-2776
US

V. Phone/Fax

Practice location:
  • Phone: 954-983-5330
  • Fax: 954-983-5086
Mailing address:
  • Phone: 954-983-5330
  • Fax: 954-983-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME88666
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME88666
License Number StateFL

VIII. Authorized Official

Name: ALEXANDER PUSHKA
Title or Position: OWNER
Credential: MD
Phone: 954-579-1110