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General NPI Number Information
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NPI Number | 1851561419
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Entity Type | Individual
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Provider Name | REESA ROBERTS PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 1090 VERMONT AVE NW SUITE 1000
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City | WASHINGTON
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State | DC
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Zip | 20005-4905
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Country | US
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Telephone | 212-965-6950
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Fax | 212-965-7030
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Provider Business Mailing Address
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Address Line | 3209 LIVE OAK LN
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City | FORT PIERCE
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State | FL
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Zip | 34981-4502
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Country | US
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Telephone | 212-965-6950
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Fax | 212-965-7030
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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 | 006620
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License Number State | NY
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