Provider Demographics
NPI:1164585048
Name:TULIER-PASTEWSKI, WALESKA M (MD)
Entity Type:Individual
Prefix:DR
First Name:WALESKA
Middle Name:M
Last Name:TULIER-PASTEWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 N BAYSHORE DR # A-2041
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1180
Mailing Address - Country:US
Mailing Address - Phone:631-332-0020
Mailing Address - Fax:
Practice Address - Street 1:1717 N BAYSHORE DR # A-2041
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1180
Practice Address - Country:US
Practice Address - Phone:631-332-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270657100Medicaid
FLG14495Medicare UPIN
FL270657100Medicaid