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General NPI Number Information
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NPI Number | 1285940841
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Entity Type | Individual
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Provider Name | DAYANA ALEXANDRA CANNAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 703 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07503
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Country | US
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Telephone | 862-207-7510
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Fax | 862-257-1688
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Provider Business Mailing Address
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Address Line | 254 FLORAL LN
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5041
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Country | US
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Telephone | 973-634-2336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00318800
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License Number State | NJ
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