Provider Demographics
NPI:1649338625
Name:SYEDA-MIAN, MAYANAZ (MD)
Entity type:Individual
Prefix:
First Name:MAYANAZ
Middle Name:
Last Name:SYEDA-MIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 REATA DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1153
Mailing Address - Country:US
Mailing Address - Phone:972-375-7821
Mailing Address - Fax:
Practice Address - Street 1:4009 OLD DENTON RD
Practice Address - Street 2:114-199
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1000
Practice Address - Country:US
Practice Address - Phone:972-855-8860
Practice Address - Fax:682-200-2850
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL55822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174155501Medicaid
TX174155502Medicaid
TX8V5791OtherBCBS
TX174155501Medicaid
TX8D6495Medicare PIN
TXG20761Medicare UPIN
TXP00362522Medicare PIN