Provider Demographics
NPI:1982145710
Name:PAQUETTE, ALY GOLDFARB (PA-C)
Entity Type:Individual
Prefix:
First Name:ALY
Middle Name:GOLDFARB
Last Name:PAQUETTE
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 1:1551 RENAISSANCE TOWNE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7676
Mailing Address - Country:US
Mailing Address - Phone:801-295-7200
Mailing Address - Fax:
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR STE 400
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7676
Practice Address - Country:US
Practice Address - Phone:801-295-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant