Provider Demographics
NPI:1336312644
Name:RAMPERSAD, JAIYA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAIYA
Middle Name:
Last Name:RAMPERSAD
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 1:1377 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4131
Mailing Address - Country:US
Mailing Address - Phone:631-647-3265
Mailing Address - Fax:631-647-3266
Practice Address - Street 1:1377 5TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4131
Practice Address - Country:US
Practice Address - Phone:631-647-3265
Practice Address - Fax:631-647-3266
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012430363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400037471Medicare PIN