Provider Demographics
NPI:1932570686
Name:ABRAHAM, JAMELLAH (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMELLAH
Middle Name:
Last Name:ABRAHAM
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 1:700 SW 78TH AVE
Mailing Address - Street 2:APT 922
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3298
Mailing Address - Country:US
Mailing Address - Phone:321-432-6252
Mailing Address - Fax:
Practice Address - Street 1:17180 ROYAL PALM BLVD
Practice Address - Street 2:SUITE # 3
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2394
Practice Address - Country:US
Practice Address - Phone:954-482-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant