Healthcare Provider Details

I. General information

NPI: 1194523522
Provider Name (Legal Business Name): AYSHA PAXMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS AYSHA SAMI

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALLACE WAY
GRANDVIEW WA
98930-8805
US

IV. Provider business mailing address

1000 WALLACE WAY
GRANDVIEW WA
98930-8805
US

V. Phone/Fax

Practice location:
  • Phone: 509-882-3444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61663558
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: