Provider Demographics
NPI:1720551955
Name:PAYAN, AGIANIT
Entity Type:Individual
Prefix:
First Name:AGIANIT
Middle Name:
Last Name:PAYAN
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 1:155 NAHKODA DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4417
Mailing Address - Country:US
Mailing Address - Phone:786-991-7325
Mailing Address - Fax:
Practice Address - Street 1:155 NAHKODA DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-4417
Practice Address - Country:US
Practice Address - Phone:786-991-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0179926100Medicaid