Provider Demographics
NPI:1962593244
Name:STYLIADIS, NOREEN ANN (PAC)
Entity type:Individual
Prefix:
First Name:NOREEN
Middle Name:ANN
Last Name:STYLIADIS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:NOREEN
Other - Middle Name:
Other - Last Name:WORLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6042 MONTEVERDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6042 MONTEVERDE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-4430
Practice Address - Country:US
Practice Address - Phone:408-440-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q19217Medicare UPIN
NJ080825Medicare ID - Type Unspecified