1649338625 NPI number — MAYANAZ SYEDA-MIAN M.D.

Table of content: MAYANAZ SYEDA-MIAN M.D. (NPI 1649338625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649338625 NPI number — MAYANAZ SYEDA-MIAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYEDA-MIAN
Provider First Name:
MAYANAZ
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649338625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 REATA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75010-1153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-375-7821
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4009 OLD DENTON RD
Provider Second Line Business Practice Location Address:
114-199
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75007-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-855-8860
Provider Business Practice Location Address Fax Number:
682-200-2850
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  L5582 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 174155501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174155502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8V5791 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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