Healthcare Provider Details

I. General information

NPI: 1356260681
Provider Name (Legal Business Name): AUREVIA MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SILVERSTONE DR STE 125
PLANO TX
75023-7874
US

IV. Provider business mailing address

3400 SILVERSTONE DR STE 125
PLANO TX
75023-7874
US

V. Phone/Fax

Practice location:
  • Phone: 270-263-2698
  • Fax: 346-771-1189
Mailing address:
  • Phone: 270-263-2698
  • Fax: 346-771-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SYED ZAKIUDDIN
Title or Position: DME
Credential:
Phone: 270-263-2698