Provider Demographics
NPI:1902610124
Name:AYE, PYU SAN DA
Entity type:Individual
Prefix:
First Name:PYU
Middle Name:SAN DA
Last Name:AYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1749
Mailing Address - Country:US
Mailing Address - Phone:531-207-5504
Mailing Address - Fax:
Practice Address - Street 1:4901 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1749
Practice Address - Country:US
Practice Address - Phone:531-207-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant