Provider Demographics
NPI:1477502888
Name:PAULEY, AYA (PA-C)
Entity Type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:PAULEY
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 1:2877 WELLNESS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8396
Mailing Address - Country:US
Mailing Address - Phone:386-668-4650
Mailing Address - Fax:386-668-4649
Practice Address - Street 1:2877 WELLNESS AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8396
Practice Address - Country:US
Practice Address - Phone:386-668-4650
Practice Address - Fax:386-668-4649
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291453101Medicaid
FLE8891WMedicare PIN
FL291453101Medicaid