Provider Demographics
NPI:1538185780
Name:DAFASHY, DEYA JACOB (MD)
Entity type:Individual
Prefix:
First Name:DEYA
Middle Name:JACOB
Last Name:DAFASHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 890827
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-0827
Mailing Address - Country:US
Mailing Address - Phone:281-991-7603
Mailing Address - Fax:281-991-7675
Practice Address - Street 1:5119 FAIRMONT PKWY STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3727
Practice Address - Country:US
Practice Address - Phone:281-991-7603
Practice Address - Fax:281-991-7675
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1026207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141940902Medicaid
TXH36457Medicare UPIN
TX141940902Medicaid