MEDICARE: MS. SYDNEY HARASYM PA

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	363A00000X	Physician Assistant	PA1841	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y0K1N	OTHER	FL	FL BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1598190084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SYDNEY HARASYM PA

Provider Business Mailing Address
First Line	:	2831 BUSINESS PARK CT STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9010
Country	:	US
Telephone Number	:	702-844-8143
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 BUSINESS PARK CT STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9010
Country	:	US
Telephone Number	:	702-844-8143
Fax Number	:

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

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	04/26/2019

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