Provider Demographics
NPI:1619244696
Name:KSIAZK, DEVON T (PA)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:T
Last Name:KSIAZK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:T
Other - Last Name:RUEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7281 SAWMILL ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016
Mailing Address - Country:US
Mailing Address - Phone:614-764-0707
Mailing Address - Fax:614-764-1707
Practice Address - Street 1:400 ALTAIR PKWY STE 3200
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7653
Practice Address - Country:US
Practice Address - Phone:614-392-5160
Practice Address - Fax:614-764-1707
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant