MEDICARE: MRS. ALYSE R WAYNE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	007301-1	NY

General Provider Information

NPI Number	:	1407954985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALYSE R WAYNE PA

Provider Business Mailing Address
First Line	:	14094 ROCK SALT RD
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2256
Country	:	US
Telephone Number	:	917-697-3542
Fax Number	:

Provider Business Practice Location Address
First Line	:	14094 ROCK SALT RD
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2256
Country	:	US
Telephone Number	:	917-697-3542
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/21/2025

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