Provider Demographics
NPI:1457086985
Name:AYAN WELLNESS
Entity Type:Organization
Organization Name:AYAN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-857-8445
Mailing Address - Street 1:1046 S FLORIDA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1118
Mailing Address - Country:US
Mailing Address - Phone:863-816-3449
Mailing Address - Fax:
Practice Address - Street 1:1046 S FLORIDA AVE STE C
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1118
Practice Address - Country:US
Practice Address - Phone:863-816-3449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty