Provider Demographics
NPI:1326275504
Name:GASTON, AYANA KAI (LMT)
Entity type:Individual
Prefix:
First Name:AYANA
Middle Name:KAI
Last Name:GASTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-1926
Mailing Address - Country:US
Mailing Address - Phone:516-578-2136
Mailing Address - Fax:
Practice Address - Street 1:1 BROADCAST PLZ STE 1
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3467
Practice Address - Country:US
Practice Address - Phone:516-218-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist