Provider Demographics
NPI:1386181667
Name:AVAKYAN, DIANA (PA-C MS)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:AVAKYAN
Suffix:
Gender:F
Credentials:PA-C MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8177 GLADES ROAD
Mailing Address - Street 2:BAY25
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3285
Mailing Address - Country:US
Mailing Address - Phone:561-955-0525
Mailing Address - Fax:
Practice Address - Street 1:8177 GLADES ROAD
Practice Address - Street 2:BAY25
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3285
Practice Address - Country:US
Practice Address - Phone:561-955-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020543363AM0700X
FLPA9115755363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical