Provider Demographics
NPI:1215379649
Name:MANNING, DYANA (PA)
Entity Type:Individual
Prefix:
First Name:DYANA
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 DAYAN ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1100
Mailing Address - Country:US
Mailing Address - Phone:315-375-5558
Mailing Address - Fax:
Practice Address - Street 1:5402 DAYAN ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1100
Practice Address - Country:US
Practice Address - Phone:315-375-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant