Provider Demographics
NPI:1972688612
Name:KASHDAN, DEBORAH ULLIAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ULLIAN
Last Name:KASHDAN
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 1:10610 PINEADA CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4915
Mailing Address - Country:US
Mailing Address - Phone:561-738-6524
Mailing Address - Fax:
Practice Address - Street 1:10075 JOG RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3535
Practice Address - Country:US
Practice Address - Phone:561-736-4321
Practice Address - Fax:561-733-2466
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1088363A00000X
FL002765363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS88482Medicare UPIN
FLE30312Medicare ID - Type Unspecified