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Individual

DEIONTE TAUN HARRILLA-GRAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1412 FAIRMOUNT AVE, PHILADELPHIA, PA 19130-2908
(215) 684-5344
Mailing address
1412 FAIRMOUNT AVE, PHILADELPHIA, PA 19130-2908

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
031202
NY
363A00000X
Physician Assistant
MA065666
PA
363A00000X
Physician Assistant
Primary
OA006887
PA

Other

Enumeration date
11/27/2023
Last updated
07/03/2024
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