Provider Demographics
NPI:1497390819
Name:KISHEL, ALEXA (PA)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:KISHEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-522-3355
Mailing Address - Fax:954-522-9590
Practice Address - Street 1:1601 S ANDREWS AVE FL 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2509
Practice Address - Country:US
Practice Address - Phone:954-522-3355
Practice Address - Fax:954-522-9590
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2024-04-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant