Provider Demographics
NPI:1629682752
Name:HUENEFELD, OLESYA
Entity Type:Individual
Prefix:
First Name:OLESYA
Middle Name:
Last Name:HUENEFELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLESYA
Other - Middle Name:
Other - Last Name:AZAROV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:249 ISLESBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7242
Mailing Address - Country:US
Mailing Address - Phone:386-986-0335
Mailing Address - Fax:
Practice Address - Street 1:249 ISLESBROOK PKWY
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7242
Practice Address - Country:US
Practice Address - Phone:386-986-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant