Provider Demographics
NPI:1558004697
Name:MAYE, GABRIELLA (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:MAYE
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 1:9001 DIGGES RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4414
Mailing Address - Country:US
Mailing Address - Phone:703-369-5000
Mailing Address - Fax:
Practice Address - Street 1:24805 PINEBROOK RD STE 317
Practice Address - Street 2:
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-4127
Practice Address - Country:US
Practice Address - Phone:703-722-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant