Provider Demographics
NPI:1922603190
Name:WEISS, AYELA DENISE
Entity Type:Individual
Prefix:
First Name:AYELA
Middle Name:DENISE
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 DENTON BOULEVARD NW
Mailing Address - Street 2:UNIT 1
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-5131
Mailing Address - Country:US
Mailing Address - Phone:850-583-6522
Mailing Address - Fax:
Practice Address - Street 1:679 DENTON BLVD NW UNIT 1
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-5131
Practice Address - Country:US
Practice Address - Phone:850-583-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula