Healthcare Provider Details

I. General information

NPI: 1518150309
Provider Name (Legal Business Name): ANNA STASSIY P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2797 OCEAN PARKWAY 3RD FLOOR
BROOKLYN NY
11235-7868
US

IV. Provider business mailing address

2797 OCEAN PARKWAY 3RD FLOOR
BROOKLYN NY
11235-7210
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-4000
  • Fax: 718-615-4004
Mailing address:
  • Phone: 718-615-4000
  • Fax: 718-615-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: