Provider Demographics
NPI:1649276254
Name:DECHAINE, CAROLYN A (PA - C)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:DECHAINE
Suffix:
Gender:
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:843-277-9070
Practice Address - Street 1:915 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6230
Practice Address - Country:US
Practice Address - Phone:725-220-8667
Practice Address - Fax:833-749-0353
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1649276254Medicaid
NVP00370835OtherRAILROAD MEDICARE
NVP00370835OtherRAILROAD MEDICARE
NVP97778Medicare UPIN
NV103356Medicare PIN
NVFZ668Z (CQ328A)Medicare PIN