Provider Demographics
NPI:1053161414
Name:VAZ, RHIANNON (PA-C)
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:
Last Name:VAZ
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 1:871 RALEIGH DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5610
Mailing Address - Country:US
Mailing Address - Phone:732-703-8836
Mailing Address - Fax:
Practice Address - Street 1:368 LAKEHURST RD STE 205
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7339
Practice Address - Country:US
Practice Address - Phone:732-914-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant