Provider Demographics
NPI:1588763924
Name:KAFOREY, LINDA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:KAFOREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:ABOU-DIAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:16635 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-9634
Mailing Address - Country:US
Mailing Address - Phone:216-225-6939
Mailing Address - Fax:
Practice Address - Street 1:8927 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8701
Practice Address - Country:US
Practice Address - Phone:216-621-5600
Practice Address - Fax:440-442-5623
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-000767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ABPA17602Medicare ID - Type Unspecified
P36946Medicare UPIN