MEDICARE: ANETA DADASHEV PHYSICIAN ASSISTANT

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	PA9104589	FL
2	363AS0400X	Surgical Physician Assistant	011476	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942335492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANETA DADASHEV PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	2706 GRIFFIN RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5856
Country	:	US
Telephone Number	:	954-544-5917
Fax Number	:	954-924-1540

Provider Business Practice Location Address
First Line	:	2706 GRIFFIN RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5856
Country	:	US
Telephone Number	:	954-544-5917
Fax Number	:	954-924-1540

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	06/24/2026

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