Healthcare Provider Details

I. General information

NPI: 1407033962
Provider Name (Legal Business Name): DORALYN MAYA-AZOULAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORALYN MAYA

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD SUITE 980
MIAMI BEACH FL
33140-4556
US

IV. Provider business mailing address

4308 ALTON RD SUITE 980
MIAMI BEACH FL
33140-4556
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-6770
  • Fax: 305-674-6704
Mailing address:
  • Phone: 305-674-6770
  • Fax: 305-674-6704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104470
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: