Provider Demographics
NPI:1942765581
Name:BASHA, LYA (DPM)
Entity Type:Individual
Prefix:
First Name:LYA
Middle Name:
Last Name:BASHA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LYA
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 N MCMULLEN BOOTH RD STE A2-2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2100
Mailing Address - Country:US
Mailing Address - Phone:727-725-2719
Mailing Address - Fax:
Practice Address - Street 1:1700 N MCMULLEN BOOTH RD STE A2-2
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2100
Practice Address - Country:US
Practice Address - Phone:727-725-2719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1071710213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery