Provider Demographics
NPI:1811256282
Name:MIYASAKI, GARY ANDREW (AUD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ANDREW
Last Name:MIYASAKI
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-339-5441
Mailing Address - Fax:425-259-1155
Practice Address - Street 1:3927 RUCKER AVE # 425339
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-339-5441
Practice Address - Fax:425-259-1155
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2760231H00000X
WALD60178672231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist