Provider Demographics
NPI:1730911710
Name:WING, ARYANA J (PA-C)
Entity type:Individual
Prefix:
First Name:ARYANA
Middle Name:J
Last Name:WING
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 1:120 GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8709
Mailing Address - Country:US
Mailing Address - Phone:607-972-5350
Mailing Address - Fax:
Practice Address - Street 1:120 GLENDALE ST
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8709
Practice Address - Country:US
Practice Address - Phone:607-972-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant