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General NPI Number Information
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NPI Number | 1851586986
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Entity Type | Individual
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Provider Name | ALYSSA C MILES PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1304 BUCKLEY RD STE 200 NEPHROLOGY ASSOCIATES OF SYRACUSE, PC
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City | SYRACUSE
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State | NY
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Zip | 13212-4317
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Country | US
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Telephone | 315-478-3311
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Fax | 315-476-5211
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Provider Business Mailing Address
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Address Line | 1304 BUCKLEY RD STE 200 NEPHROLOGY ASSOCIATES OF SYRACUSE, PC
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City | SYRACUSE
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State | NY
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Zip | 13212-4317
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Country | US
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Telephone | 315-478-3311
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Fax | 315-476-5211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 012015-1
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License Number State | NY
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