Provider Demographics
NPI:1033892294
Name:ESPADAS, MICHAELA (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:ESPADAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E MILL DR APT 3G
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4083
Mailing Address - Country:US
Mailing Address - Phone:516-581-3266
Mailing Address - Fax:
Practice Address - Street 1:2 E MILL DR APT 3G
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4083
Practice Address - Country:US
Practice Address - Phone:516-581-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant