Provider Demographics
NPI:1457658023
Name:DODEA, YANA (PA-C)
Entity Type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:DODEA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:YANA
Other - Middle Name:
Other - Last Name:TASHLITSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 NE 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2945
Mailing Address - Country:US
Mailing Address - Phone:954-699-5161
Mailing Address - Fax:
Practice Address - Street 1:815 NE 27TH AVE
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2945
Practice Address - Country:US
Practice Address - Phone:954-699-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105920363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant