Provider Demographics
NPI:1437737384
Name:ETYEM, AYAH TOUFICK
Entity Type:Individual
Prefix:
First Name:AYAH
Middle Name:TOUFICK
Last Name:ETYEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 UNIVERSITY PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2973
Mailing Address - Country:US
Mailing Address - Phone:941-351-1200
Mailing Address - Fax:941-351-1201
Practice Address - Street 1:2401 UNIVERSITY PKWY STE 205
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2973
Practice Address - Country:US
Practice Address - Phone:941-351-1200
Practice Address - Fax:941-351-1201
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115637363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical