Provider Demographics
NPI:1720445455
Name:ARYA-SANDE, SEPIDEH (PA-C)
Entity Type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:ARYA-SANDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SEPIDEH
Other - Middle Name:
Other - Last Name:ARYA-SANDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:4796 CAUGHLIN PKWY STE 108
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0910
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3900
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
13684095OtherCAQH
NVV113422Medicare PIN