Healthcare Provider Details

I. General information

NPI: 1851965578
Provider Name (Legal Business Name): HELY ESAA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 W 10TH PL STE 100
MESA AZ
85201-3499
US

IV. Provider business mailing address

3877 N 7TH ST
PHOENIX AZ
85014-5072
US

V. Phone/Fax

Practice location:
  • Phone: 407-723-9787
  • Fax:
Mailing address:
  • Phone: 407-723-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8516
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number699PA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: