Provider Demographics
NPI:1114012101
Name:BYKER, SARALYN R (PA-C)
Entity Type:Individual
Prefix:
First Name:SARALYN
Middle Name:R
Last Name:BYKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 E SOUTHERN AVE STE 13A
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5251
Mailing Address - Country:US
Mailing Address - Phone:602-393-7501
Mailing Address - Fax:480-733-2776
Practice Address - Street 1:1818 E SOUTHERN AVE STE 13A
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5251
Practice Address - Country:US
Practice Address - Phone:602-393-7501
Practice Address - Fax:480-733-2740
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6665OtherSTATE LICENSE
MI5601002636OtherSTATE LICENSE