Provider Demographics
NPI:1154485829
Name:ELLINGTON, DICKSON AARON (PA)
Entity Type:Individual
Prefix:
First Name:DICKSON
Middle Name:AARON
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 530442
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33153-0442
Mailing Address - Country:US
Mailing Address - Phone:786-390-5424
Mailing Address - Fax:305-754-9387
Practice Address - Street 1:1405 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5732
Practice Address - Country:US
Practice Address - Phone:305-624-9191
Practice Address - Fax:305-643-7772
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL3313363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical