Provider Demographics
NPI:1063720555
Name:SYLVIA, MIA P (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:P
Last Name:SYLVIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SAINT CLAIR RD
Mailing Address - Street 2:
Mailing Address - City:BOYCE
Mailing Address - State:LA
Mailing Address - Zip Code:71409-9006
Mailing Address - Country:US
Mailing Address - Phone:318-528-3223
Mailing Address - Fax:
Practice Address - Street 1:415 SAINT CLAIR RD
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:LA
Practice Address - Zip Code:71409-9006
Practice Address - Country:US
Practice Address - Phone:318-528-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200365363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant