Provider Demographics
NPI:1649152992
Name:BUSBY, FERNANDO JUAN (PA)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:JUAN
Last Name:BUSBY
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:AUSPEX DIAMOND LLC
Mailing Address - Street 2:9169 W STATE ST # 2079
Mailing Address - City:GARDEN CITY,
Mailing Address - State:ID
Mailing Address - Zip Code:83714
Mailing Address - Country:US
Mailing Address - Phone:304-459-9808
Mailing Address - Fax:
Practice Address - Street 1:AUSPEX DIAMOND LLC ST # 2079
Practice Address - Street 2:9169 W STATE
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714
Practice Address - Country:US
Practice Address - Phone:304-459-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical