Provider Demographics
NPI:1851561419
Name:ROBERTS, REESA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:REESA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3209 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-4502
Mailing Address - Country:US
Mailing Address - Phone:212-965-6950
Mailing Address - Fax:212-965-7030
Practice Address - Street 1:1090 VERMONT AVE NW
Practice Address - Street 2:SUITE 1000
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4905
Practice Address - Country:US
Practice Address - Phone:212-965-6950
Practice Address - Fax:212-965-7030
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant