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General NPI Number Information
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NPI Number | 1518009497
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Entity Type | Individual
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Provider Name | SVETLANA REYBLAT PA-C, MPH
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5258 LINTON BLVD STE 306
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6530
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Country | US
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Telephone | 561-498-2911
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Fax |
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Provider Business Mailing Address
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Address Line | 7318 PANACHE WAY
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City | BOCA RATON
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State | FL
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Zip | 33433-6921
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Country | US
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Telephone | 561-361-9420
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-3743
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License Number State | FL
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