Provider Demographics
NPI:1407438005
Name:REYNOLDS, SYVILLA GRATON (PA)
Entity Type:Individual
Prefix:
First Name:SYVILLA
Middle Name:GRATON
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 E PRATER WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9688
Mailing Address - Country:US
Mailing Address - Phone:775-356-4888
Mailing Address - Fax:775-356-4890
Practice Address - Street 1:2385 E PRATER WAY STE 205
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9688
Practice Address - Country:US
Practice Address - Phone:775-356-4888
Practice Address - Fax:775-356-4890
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61157812363AS0400X
NVPA2772363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical