Provider Demographics
NPI:1558951590
Name:KUNEFF, ALENA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:KUNEFF
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 1:19905 DINNER KEY DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4507
Mailing Address - Country:US
Mailing Address - Phone:813-531-3105
Mailing Address - Fax:
Practice Address - Street 1:7251 W PALMETTO PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3487
Practice Address - Country:US
Practice Address - Phone:561-990-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9109852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant