Provider Demographics
NPI:1104532712
Name:OLAYA, JOHANNA (PA-C)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:OLAYA
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 1:1435 26TH AVE APT 1R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3510
Mailing Address - Country:US
Mailing Address - Phone:571-253-1762
Mailing Address - Fax:
Practice Address - Street 1:9420 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11451-0002
Practice Address - Country:US
Practice Address - Phone:718-262-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant