Provider Demographics
NPI:1790175800
Name:CICHON, ABIGAIL LEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:LEE
Last Name:CICHON
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 1:580 CHRISTINA DR
Mailing Address - Street 2:APT 207
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33414-2173
Mailing Address - Country:US
Mailing Address - Phone:708-609-3511
Mailing Address - Fax:
Practice Address - Street 1:601 N CONGRESS AVE STE 402
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4639
Practice Address - Country:US
Practice Address - Phone:708-609-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108579363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical