Provider Demographics
NPI:1184145609
Name:ZILBERBERG, KACEY SABRA (PA-C)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:SABRA
Last Name:ZILBERBERG
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 1:1504 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2144
Mailing Address - Country:US
Mailing Address - Phone:561-699-1026
Mailing Address - Fax:
Practice Address - Street 1:1504 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2144
Practice Address - Country:US
Practice Address - Phone:305-773-8156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant