Basic Information
Provider Information
NPI: 1003294570
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MYLES
FirstName: NAHEEM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4575 SE DIXIE HWY
Address2:  
City: STUART
State: FL
PostalCode: 349976826
CountryCode: US
TelephoneNumber: 8558326727
FaxNumber: 7726759100
Practice Location
Address1: 4575 SE DIXIE HWY
Address2:  
City: STUART
State: FL
PostalCode: 349976826
CountryCode: US
TelephoneNumber: 8558326727
FaxNumber: 7726759100
Other Information
ProviderEnumerationDate: 05/15/2015
LastUpdateDate: 05/15/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
247200000X  Y Technologists, Technicians & Other Technical Service ProvidersTechnician, Other 

No ID Information.


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