MEDICARE: MRS. NISHITA MILAN CORNYN PA-C

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	PA14495	TX

General Provider Information

NPI Number	:	1952994592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NISHITA MILAN CORNYN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 10597
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78766-1597
Country	:	US
Telephone Number	:	512-485-5889
Fax Number	:	512-420-0397

Provider Business Practice Location Address
First Line	:	4310 JAMES CASEY ST STE 4A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1120
Country	:	US
Telephone Number	:	512-448-4588
Fax Number	:	512-445-4511

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

Provider Enumeration Date	:	02/15/2021
Last Update Date	:	05/19/2026

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