Provider Demographics
NPI:1003001058
Name:BELANGER, AYUMI E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AYUMI
Middle Name:E
Last Name:BELANGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32050-1978
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-282-1550
Practice Address - Street 1:91 BRANSCOMB RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-7223
Practice Address - Country:US
Practice Address - Phone:904-861-1034
Practice Address - Fax:904-861-1037
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104224363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292842600Medicaid