Provider Demographics
NPI:1861205395
Name:KAISER, MAYA KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:KATHERINE
Last Name:KAISER
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 1:640 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4327
Mailing Address - Country:US
Mailing Address - Phone:321-634-4799
Mailing Address - Fax:
Practice Address - Street 1:1251 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3221
Practice Address - Country:US
Practice Address - Phone:321-434-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125760700Medicaid
FLUN350OtherMEDICARE HFPS
FLUN352OtherMEDICARE HF