Healthcare Provider Details

I. General information

NPI: 1376166439
Provider Name (Legal Business Name): STEPHANIE AYA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 COLLIER BLVD
NAPLES FL
34116-4005
US

IV. Provider business mailing address

142 S PORTLAND AVE APT 709
BROOKLYN NY
11217-5421
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3000
  • Fax:
Mailing address:
  • Phone: 305-484-0342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number062640
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN26851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: