Healthcare Provider Details

I. General information

NPI: 1063631760
Provider Name (Legal Business Name): SYLVIA ELIZABETH MCMINN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S 7TH AVE STE 200
PHOENIX AZ
85007-4076
US

IV. Provider business mailing address

10710 E BECKER LN
SCOTTSDALE AZ
85259-3873
US

V. Phone/Fax

Practice location:
  • Phone: 623-236-2000
  • Fax:
Mailing address:
  • Phone: 928-589-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003413-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00667
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberNMPA20070013
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5672
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: