Provider Demographics
NPI:1063130912
Name:COLLADO, AYANA
Entity type:Individual
Prefix:
First Name:AYANA
Middle Name:
Last Name:COLLADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1919
Mailing Address - Country:US
Mailing Address - Phone:917-470-8647
Mailing Address - Fax:
Practice Address - Street 1:1401 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2073
Practice Address - Country:US
Practice Address - Phone:973-314-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional