Provider Demographics
NPI:1487369047
Name:YAVARI, ALLISON LOU (DMSC, PA-C)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:LOU
Last Name:YAVARI
Suffix:
Gender:F
Credentials:DMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0968
Mailing Address - Country:US
Mailing Address - Phone:919-928-4172
Mailing Address - Fax:
Practice Address - Street 1:113 E 39TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0968
Practice Address - Country:US
Practice Address - Phone:212-223-0716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0009306363AS0400X
NJ25MP00842100363AS0400X
FLPA9117092363AS0400X
NY031590363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical