MEDICARE: MRS. AGNIESZKA ONICHIMIUK PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0126381	NY
2	363A00000X	Physician Assistant	PA9114642	FL

General Provider Information

NPI Number	:	1245488113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AGNIESZKA ONICHIMIUK PA

Provider Business Mailing Address
First Line	:	PO BOX 20800
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4105
Country	:	US
Telephone Number	:	888-402-7256
Fax Number	:	888-902-1099

Provider Business Practice Location Address
First Line	:	9980 CENTRAL PARK BLVD N STE 304
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1704
Country	:	US
Telephone Number	:	561-483-8335
Fax Number	:	561-483-1756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	07/11/2024

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