Provider Demographics
NPI:1295379444
Name:REZNITSKY, CELIA (PA-C)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:REZNITSKY
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 1:1101 NE 170TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2633
Mailing Address - Country:US
Mailing Address - Phone:305-989-9367
Mailing Address - Fax:
Practice Address - Street 1:2630 NE 203RD ST STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1903
Practice Address - Country:US
Practice Address - Phone:305-692-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant