Provider Demographics
NPI:1851186225
Name:ATALLAH, MAYA (PA-C)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:ATALLAH
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 1:32000 NORTHWESTERN HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1569
Mailing Address - Country:US
Mailing Address - Phone:248-918-0800
Mailing Address - Fax:248-918-2131
Practice Address - Street 1:32000 NORTHWESTERN HWY STE 120
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1569
Practice Address - Country:US
Practice Address - Phone:248-918-0800
Practice Address - Fax:248-918-2131
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical