Provider Demographics
NPI:1730470824
Name:SAYAPHET, PHONVILAY (HIS)
Entity Type:Individual
Prefix:
First Name:PHONVILAY
Middle Name:
Last Name:SAYAPHET
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3677 CALDER AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5027
Mailing Address - Country:US
Mailing Address - Phone:409-839-4900
Mailing Address - Fax:409-839-4901
Practice Address - Street 1:3677 CALDER AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5027
Practice Address - Country:US
Practice Address - Phone:409-839-4900
Practice Address - Fax:409-839-4901
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1209237700000X
TX80388237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist