Provider Demographics
NPI:1760956247
Name:SHIYOU, SIERA CHEYENNE (PA)
Entity Type:Individual
Prefix:
First Name:SIERA
Middle Name:CHEYENNE
Last Name:SHIYOU
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 1:1060 MEADOW HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-6020
Mailing Address - Country:US
Mailing Address - Phone:601-347-7709
Mailing Address - Fax:
Practice Address - Street 1:1060 MEADOW HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-6020
Practice Address - Country:US
Practice Address - Phone:601-347-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant