Provider Demographics
NPI:1871830299
Name:LYDAY, VANYA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:VANYA
Middle Name:ELIZABETH
Last Name:LYDAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VANYA
Other - Middle Name:ELIZABETH
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:272 S COLLINS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4643
Mailing Address - Country:US
Mailing Address - Phone:972-663-5780
Mailing Address - Fax:972-663-5785
Practice Address - Street 1:272 S COLLINS RD STE 200
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4643
Practice Address - Country:US
Practice Address - Phone:972-663-5780
Practice Address - Fax:972-663-5785
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX315156501Medicaid
TX315156501Medicaid
TX272153YKY6Medicare PIN