Provider Demographics
NPI:1154697753
Name:MOTTAHEDEH, AYELET (PA)
Entity type:Individual
Prefix:
First Name:AYELET
Middle Name:
Last Name:MOTTAHEDEH
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:623 STEWART AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4771
Mailing Address - Country:US
Mailing Address - Phone:516-650-3355
Mailing Address - Fax:866-706-0812
Practice Address - Street 1:623 STEWART AVE STE 106
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4771
Practice Address - Country:US
Practice Address - Phone:516-650-3355
Practice Address - Fax:866-706-0812
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant