Provider Demographics
NPI:1922645993
Name:BANAYAN, MICHELLE ROYA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROYA
Last Name:BANAYAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:17661 CORINTHIAN DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3702
Mailing Address - Country:US
Mailing Address - Phone:818-903-7064
Mailing Address - Fax:
Practice Address - Street 1:16133 VENTURA BLVD STE 340
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2428
Practice Address - Country:US
Practice Address - Phone:818-788-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2021-08-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant