Provider Demographics
NPI:1730433483
Name:KUSHNER, YAEL EVA (PA-C)
Entity type:Individual
Prefix:MS
First Name:YAEL
Middle Name:EVA
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:YAEL
Other - Middle Name:EVA
Other - Last Name:ASSIDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2699 STIRLING RD STE B100
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6543
Mailing Address - Country:US
Mailing Address - Phone:305-223-8808
Mailing Address - Fax:954-962-9657
Practice Address - Street 1:2699 STIRLING RD STE B305
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6546
Practice Address - Country:US
Practice Address - Phone:954-981-9180
Practice Address - Fax:954-961-4752
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106870207K00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009693800Medicaid