Provider Demographics
NPI:1801880778
Name:AYE-MAUNG, MARIA SHELLANE CRISOSTOMO (PA-C)
Entity type:Individual
Prefix:
First Name:MARIA SHELLANE
Middle Name:CRISOSTOMO
Last Name:AYE-MAUNG
Suffix:
Gender:F
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 1:2 BOYNTON CT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1305
Mailing Address - Country:US
Mailing Address - Phone:415-845-5571
Mailing Address - Fax:
Practice Address - Street 1:2 BOYNTON CT
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1305
Practice Address - Country:US
Practice Address - Phone:415-845-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010419-1363AM0700X
CAPA18431363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant