Provider Demographics
NPI:1427693977
Name:LAU, ANAYS (PA-C)
Entity type:Individual
Prefix:
First Name:ANAYS
Middle Name:
Last Name:LAU
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 1:8401 SW 107TH AVE APT 122E
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4334
Mailing Address - Country:US
Mailing Address - Phone:305-778-9621
Mailing Address - Fax:
Practice Address - Street 1:12550 BISCAYNE BLVD STE 226
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2501
Practice Address - Country:US
Practice Address - Phone:305-945-2411
Practice Address - Fax:305-945-2412
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA13161OtherTEXAS PHYSICIAN ASSISTANT BOARD
FLPA9113134OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH