Provider Demographics
NPI:1568051324
Name:BAYON, AMY DANIELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DANIELLE
Last Name:BAYON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:DANIELLE
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1306 CONCOURSE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1033
Mailing Address - Country:US
Mailing Address - Phone:813-493-5252
Mailing Address - Fax:813-341-3259
Practice Address - Street 1:1201 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3424
Practice Address - Country:US
Practice Address - Phone:727-442-1917
Practice Address - Fax:727-446-3490
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109881000Medicaid