Healthcare Provider Details

I. General information

NPI: 1336076843
Provider Name (Legal Business Name): SYEDA LAMIYA MIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J. CLYDE MORRIS BLVD, RIVERSIDE REGIONAL MEDICAL CE DEPARTMENT OF MEDICAL EDUCATION (ANNEX, 2ND FLOOR)
NEWPORT NEWS VA
23601
US

IV. Provider business mailing address

500 J. CLYDE MORRIS BLVD, RIVERSIDE REGIONAL MEDICAL CE DEPARTMENT OF MEDICAL EDUCATION (ANNEX, 2ND FLOOR)
NEWPORT NEWS VA
23601
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-3945
  • Fax: 757-594-3184
Mailing address:
  • Phone: 757-594-3945
  • Fax: 757-594-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: