Provider Demographics
NPI:1902843915
Name:GRAY, PAMELA A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:A
Last Name:GRAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:A
Other - Last Name:LISTIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4118 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8645
Mailing Address - Country:US
Mailing Address - Phone:239-633-6737
Mailing Address - Fax:
Practice Address - Street 1:5350 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-5812
Practice Address - Country:US
Practice Address - Phone:941-917-4500
Practice Address - Fax:941-917-4689
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101582363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical