MEDICARE: KHRYSTYNA SPLAVNYK 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	363AM0700X	Medical Physician Assistant	PA9112028	PA

General Provider Information

NPI Number	:	1730598525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHRYSTYNA SPLAVNYK PA

Provider Business Mailing Address
First Line	:	1419 SE 8TH TER STE 200
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 E COMMERCIAL BLVD STE 302
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3754
Country	:	US
Telephone Number	:	954-463-6408
Fax Number	:	954-463-9208

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	12/10/2024

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