Provider Demographics
NPI:1346864162
Name:MOTA, DAYANE (PA-C)
Entity Type:Individual
Prefix:
First Name:DAYANE
Middle Name:
Last Name:MOTA
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 1:66 SW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-2503
Mailing Address - Country:US
Mailing Address - Phone:508-816-8052
Mailing Address - Fax:
Practice Address - Street 1:66 SW MAIN ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MA
Practice Address - Zip Code:01516-2503
Practice Address - Country:US
Practice Address - Phone:508-816-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant