Provider Demographics
NPI:1033146949
Name:MILES, SHYNDA F (MD)
Entity Type:Individual
Prefix:
First Name:SHYNDA
Middle Name:F
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1553
Mailing Address - Country:US
Mailing Address - Phone:913-383-9099
Mailing Address - Fax:913-213-6026
Practice Address - Street 1:8800 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1553
Practice Address - Country:US
Practice Address - Phone:913-383-9099
Practice Address - Fax:913-213-6026
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018384208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205898901Medicaid
MO205898901Medicaid
H69871Medicare UPIN