Provider Demographics
NPI:1245576016
Name:DELIMUSTAFIC, EDIN (RPA-C)
Entity type:Individual
Prefix:
First Name:EDIN
Middle Name:
Last Name:DELIMUSTAFIC
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NICHOLLS ROAD HSC LEVEL 3
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8036
Mailing Address - Country:US
Mailing Address - Phone:631-444-2198
Mailing Address - Fax:
Practice Address - Street 1:101 NICHOLLS ROAD HSC LEVEL 3
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8036
Practice Address - Country:US
Practice Address - Phone:631-444-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016275-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant