Healthcare Provider Details

I. General information

NPI: 1679654438
Provider Name (Legal Business Name): PATRICIA SUSAN NYE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11024 MONTGOMERY BLVD NE # 277
ALBUQUERQUE NM
87111-3962
US

IV. Provider business mailing address

11024 MONTGOMERY BLVD NE # 277
ALBUQUERQUE NM
87111-3962
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-0550
  • Fax:
Mailing address:
  • Phone: 505-503-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14382
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: