Provider Demographics
NPI:1801122478
Name:GRACZYK, SYLWIA ANGELICA (PA-C)
Entity type:Individual
Prefix:
First Name:SYLWIA
Middle Name:ANGELICA
Last Name:GRACZYK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 CORONADO CENTER DR STE 211
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3992
Mailing Address - Country:US
Mailing Address - Phone:702-407-8241
Mailing Address - Fax:702-492-1728
Practice Address - Street 1:7391 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1577
Practice Address - Country:US
Practice Address - Phone:702-304-2144
Practice Address - Fax:702-304-2147
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054215363AM0700X
NVPA1285363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1801122478Medicaid