Provider Demographics
NPI:1790412088
Name:D'ENTREMONT, ALAYNA ALEXUS (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:ALAYNA
Middle Name:ALEXUS
Last Name:D'ENTREMONT
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3425
Mailing Address - Country:US
Mailing Address - Phone:843-226-0462
Mailing Address - Fax:
Practice Address - Street 1:4406 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3425
Practice Address - Country:US
Practice Address - Phone:843-226-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant