Healthcare Provider Details

I. General information

NPI: 1649956814
Provider Name (Legal Business Name): DANAYE MOKMA PEREZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANAYE ELISE MOKMA

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E DIXON BLVD
SHELBY NC
28152-6948
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-480-9344
  • Fax: 704-482-8494
Mailing address:
  • Phone: 704-730-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13482
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: