Provider Demographics
NPI:1134802390
Name:MIURA, SAYDE LYNN (FA)
Entity type:Individual
Prefix:
First Name:SAYDE
Middle Name:LYNN
Last Name:MIURA
Suffix:
Gender:F
Credentials:FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10580 N MCCARRAN BLVD # 115-316
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2059
Mailing Address - Country:US
Mailing Address - Phone:775-351-6219
Mailing Address - Fax:
Practice Address - Street 1:10580 N MCCARRAN BLVD # 115-316
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-2059
Practice Address - Country:US
Practice Address - Phone:775-351-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
23-527246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant