Provider Demographics
NPI:1578169256
Name:DAYAN, MARIA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MICHELLE
Last Name:DAYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:MICHELLE
Other - Last Name:BADALOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6812 YELLOWSTONE BLVD APT 4U
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3244
Mailing Address - Country:US
Mailing Address - Phone:646-441-7578
Mailing Address - Fax:
Practice Address - Street 1:7801 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7439
Practice Address - Country:US
Practice Address - Phone:718-386-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025946363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical