Healthcare Provider Details

I. General information

NPI: 1821903261
Provider Name (Legal Business Name): DYLAN ABEL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S UNIVERSITY AVE APT C506
PROVO UT
84601-4611
US

IV. Provider business mailing address

255 S UNIVERSITY AVE APT C506
PROVO UT
84601-4611
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-6331
  • Fax:
Mailing address:
  • Phone: 517-492-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: