Provider Demographics
NPI:1932127255
Name:KASSABIAN, CHRISTINA MICHELE (PA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MICHELE
Last Name:KASSABIAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 N ALAFAYA TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4739
Mailing Address - Country:US
Mailing Address - Phone:407-894-0005
Mailing Address - Fax:407-894-7759
Practice Address - Street 1:2000 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4739
Practice Address - Country:US
Practice Address - Phone:407-635-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2704363A00000X
FLPA2704363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291535900Medicaid
FLP82705Medicare UPIN