Provider Demographics
NPI:1285940841
Name:CANNAN, DAYANA ALEXANDRA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DAYANA
Middle Name:ALEXANDRA
Last Name:CANNAN
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 1:254 FLORAL LN
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5041
Mailing Address - Country:US
Mailing Address - Phone:973-634-2336
Mailing Address - Fax:
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503
Practice Address - Country:US
Practice Address - Phone:862-207-7510
Practice Address - Fax:862-257-1688
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00318800363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical