Provider Demographics
NPI:1104178912
Name:PEPPARD, AVIVA H (RPA-C)
Entity Type:Individual
Prefix:
First Name:AVIVA
Middle Name:H
Last Name:PEPPARD
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 76 70TH AVE
Mailing Address - Street 2:APT #2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:305-332-7335
Mailing Address - Fax:
Practice Address - Street 1:13776 70TH AVE
Practice Address - Street 2:APT 2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1926
Practice Address - Country:US
Practice Address - Phone:305-332-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant