Provider Demographics
NPI:1477258267
Name:AVAYLON, JAYCOB BRYAN
Entity Type:Individual
Prefix:
First Name:JAYCOB
Middle Name:BRYAN
Last Name:AVAYLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CONN TER STE 550
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-3206
Mailing Address - Country:US
Mailing Address - Phone:859-218-2631
Mailing Address - Fax:
Practice Address - Street 1:110 CONN TER STE 550
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3206
Practice Address - Country:US
Practice Address - Phone:859-218-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program