Provider Demographics
NPI:1518150309
Name:STASSIY, ANNA (PA)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:STASSIY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 OCEAN PARKWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7210
Mailing Address - Country:US
Mailing Address - Phone:718-615-4000
Mailing Address - Fax:718-615-4004
Practice Address - Street 1:2797 OCEAN PARKWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7868
Practice Address - Country:US
Practice Address - Phone:718-615-4000
Practice Address - Fax:718-615-4004
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012022363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012022OtherLICENCE
NY51AN22T081Medicare PIN