Provider Demographics
NPI:1255808887
Name:MILLER, OMNIYA SATORI
Entity type:Individual
Prefix:MRS
First Name:OMNIYA
Middle Name:SATORI
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5709
Mailing Address - Country:US
Mailing Address - Phone:336-809-2584
Mailing Address - Fax:
Practice Address - Street 1:3000 TWIN LAKES DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5709
Practice Address - Country:US
Practice Address - Phone:336-809-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0411129251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health