Provider Demographics
NPI:1578352423
Name:TAYAA, ALAN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:TAYAA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14421 LIGHTNER RD
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2510
Mailing Address - Country:US
Mailing Address - Phone:571-274-7007
Mailing Address - Fax:
Practice Address - Street 1:14421 LIGHTNER RD
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2510
Practice Address - Country:US
Practice Address - Phone:571-274-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001276573163W00000X
DCRN1047639163W00000X
VA0024193460363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse