Provider Demographics
NPI:1588230767
Name:STOCKHAMMER, KSENIYA (PA-C)
Entity type:Individual
Prefix:
First Name:KSENIYA
Middle Name:
Last Name:STOCKHAMMER
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 LAKEBRIDGE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:386-693-1611
Practice Address - Street 1:37 OLD KINGS RD
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8227
Practice Address - Country:US
Practice Address - Phone:386-677-9044
Practice Address - Fax:386-677-3083
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2025-02-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant