Provider Demographics
NPI:1578801536
Name:MALTSEVA, OKSANA (PA)
Entity Type:Individual
Prefix:MRS
First Name:OKSANA
Middle Name:
Last Name:MALTSEVA
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 1:19390 COLLINS AVE APT 1510
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2277
Mailing Address - Country:US
Mailing Address - Phone:305-283-8370
Mailing Address - Fax:
Practice Address - Street 1:19390 COLLINS AVE
Practice Address - Street 2:SUITE 1104
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2200
Practice Address - Country:US
Practice Address - Phone:305-283-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-27
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9107075OtherPHYSICIAN ASSISTANT LICENSE