Provider Demographics
NPI:1437824042
Name:BYAM, REBECCA ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:BYAM
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 1:95 W SQUANTUM ST APT 112
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2112
Mailing Address - Country:US
Mailing Address - Phone:845-591-4514
Mailing Address - Fax:
Practice Address - Street 1:983 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6835
Practice Address - Country:US
Practice Address - Phone:781-819-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant