Provider Demographics
NPI:1407033962
Name:MAYA-AZOULAY, DORALYN (PA-C)
Entity type:Individual
Prefix:
First Name:DORALYN
Middle Name:
Last Name:MAYA-AZOULAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DORALYN
Other - Middle Name:
Other - Last Name:MAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4308 ALTON RD
Mailing Address - Street 2:SUITE 980
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4556
Mailing Address - Country:US
Mailing Address - Phone:305-674-6770
Mailing Address - Fax:305-674-6704
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 980
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-674-6770
Practice Address - Fax:305-674-6704
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI575ZMedicare PIN