Provider Demographics
NPI:1497819395
Name:DRIVAS, PAULA (RPAC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:DRIVAS
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1101
Mailing Address - Country:US
Mailing Address - Phone:516-521-4849
Mailing Address - Fax:
Practice Address - Street 1:17 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1101
Practice Address - Country:US
Practice Address - Phone:516-521-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043071363A00000X
CA54046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant