Provider Demographics
NPI:1710124912
Name:CHUSID, BRETT AMY (PA)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:AMY
Last Name:CHUSID
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRETT
Other - Middle Name:AMY
Other - Last Name:REISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:4651 SHERIDAN ST STE 350
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3425
Practice Address - Country:US
Practice Address - Phone:954-276-8559
Practice Address - Fax:954-966-9762
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014325500Medicaid