Healthcare Provider Details

I. General information

NPI: 1295664068
Provider Name (Legal Business Name): MICHELLE N AYVAS-FONTANA FNP STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POMPTON RD
WAYNE NJ
07470-2103
US

IV. Provider business mailing address

144 WENDELL RD
EAST STROUDSBURG PA
18301-7795
US

V. Phone/Fax

Practice location:
  • Phone: 973-720-2000
  • Fax:
Mailing address:
  • Phone: 201-321-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN784036
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: