Provider Demographics
NPI:1518919588
Name:BERSHADSKI, RUDOLF (PA)
Entity Type:Individual
Prefix:
First Name:RUDOLF
Middle Name:
Last Name:BERSHADSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:RUDY
Other - Middle Name:
Other - Last Name:BERSHADSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:6101 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3900
Mailing Address - Country:US
Mailing Address - Phone:239-348-4221
Mailing Address - Fax:
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-348-4000
Practice Address - Fax:239-352-7258
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102990363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP38720OtherOPTIMUM
FL292315700Medicaid
FLP01214790OtherRAILROAD MCR
FLP116538OtherFREEDOM
FL9276504OtherCIGNA
FLQ30965Medicare UPIN
FL292315700Medicaid
FLU6831XMedicare PIN