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General NPI Number Information
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NPI Number | 1346625456
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Entity Type | Organization
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Legal Business Name | PARADIGM NEURODIAGNOSTICS LLC
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 5930 ROYAL LN STE E119
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City | DALLAS
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State | TX
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Zip | 75230-3849
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Country | US
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Telephone | 469-708-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 5930 ROYAL LN STE E119
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City | DALLAS
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State | TX
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Zip | 75230-3849
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Country | US
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Telephone | 469-708-6280
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SHAY MAYYA
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Credential | MD
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Telephone | 517-862-9343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P5324
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N9264
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License Number State | TX
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