Healthcare Provider Details

I. General information

NPI: 1033892294
Provider Name (Legal Business Name): MICHAELA ESPADAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E MILL DR APT 3G
GREAT NECK NY
11021-4083
US

IV. Provider business mailing address

2 E MILL DR APT 3G
GREAT NECK NY
11021-4083
US

V. Phone/Fax

Practice location:
  • Phone: 516-581-3266
  • Fax:
Mailing address:
  • Phone: 516-581-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number030103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: