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NPI Code Detail

MEDICARE: NAYSHA MYA ISOM M.D.

MEDICARE: NAYSHA MYA ISOM M.D.
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
1207Q00000XFamily Medicine PhysicianMD.202129LA
2207Q00000XFamily Medicine Physician17093NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275701617
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAYSHA MYA ISOM M.D.
Provider Business Mailing Address
First Line : 326 MANDARIN HILL LN
Second Line :
City : HENDERSON
State : NV
Zip : 89012-5122
Country : US
Telephone Number : 708-476-9366
Fax Number :
Provider Business Practice Location Address
First Line : 8480 S EASTERN AVE STE D
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2822
Country : US
Telephone Number : 702-487-2613
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2008
Last Update Date : 04/29/2026

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