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General NPI Number Information
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NPI Number | 1164591400
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Entity Type | Individual
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Provider Name | EDEN ASEFAW GHEBRESILASIE PA
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 18260 NE 19TH AVE SUITE 201
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-1632
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Country | US
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Telephone | 305-956-9062
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Fax | 305-354-4524
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Provider Business Mailing Address
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Address Line | 2642 COLLINS AVE APT 207
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City | MIAMI BEACH
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State | FL
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Zip | 33140
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Country | US
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Telephone | 305-215-2929
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3418
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License Number State | FL
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