Provider Demographics
NPI:1942715693
Name:MAYO, GABRIELLE ARGUELLES (PA, ATC)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ARGUELLES
Last Name:MAYO
Suffix:
Gender:F
Credentials:PA, ATC
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:DIEZ
Other - Last Name:ARGUELLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 CONFEDERATE ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2808
Mailing Address - Country:US
Mailing Address - Phone:614-832-4182
Mailing Address - Fax:
Practice Address - Street 1:800 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807-3841
Practice Address - Country:US
Practice Address - Phone:614-832-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260028602255A2300X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0126002860OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
2000028507OtherBOC