Provider Demographics
NPI:1194354738
Name:FELLIG, CHAYA (PA-C)
Entity type:Individual
Prefix:
First Name:CHAYA
Middle Name:
Last Name:FELLIG
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 1:5 ISLAND AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-1322
Mailing Address - Country:US
Mailing Address - Phone:786-543-5966
Mailing Address - Fax:
Practice Address - Street 1:550 SW 3RD ST STE 305
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6946
Practice Address - Country:US
Practice Address - Phone:954-941-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant