MEDICARE: SAYDE LYNN MIURA FA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	23-527

General Provider Information

NPI Number	:	1134802390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAYDE LYNN MIURA FA

Provider Business Mailing Address
First Line	:	10580 N MCCARRAN BLVD # 115-316
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-2059
Country	:	US
Telephone Number	:	775-351-6219
Fax Number	:

Provider Business Practice Location Address
First Line	:	10580 N MCCARRAN BLVD # 115-316
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-2059
Country	:	US
Telephone Number	:	775-351-6219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	01/11/2024

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