Provider Demographics
NPI:1417508151
Name:JAVERSAK, IRIS ALISA (PA-C)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:ALISA
Last Name:JAVERSAK
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 1:1895 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3339
Mailing Address - Country:US
Mailing Address - Phone:330-268-8604
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-375-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006017RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant