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General NPI Number Information
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NPI Number | 1073522942
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Entity Type | Individual
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Provider Name | IRINA GUTSALYUK PA
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Gender | Female
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 370 SOUTHEAST VERANDA FALLS WAY SUITE 102
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984
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Country | US
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Telephone | 772-763-1720
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Fax | 772-214-3027
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Provider Business Mailing Address
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Address Line | PO BOX 20800
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City | BELFAST
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State | ME
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Zip | 04915-4105
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Country | US
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Telephone | 888-402-7256
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Fax | 888-902-1099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 009810-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9109303
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License Number State | FL
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