Provider Demographics
NPI:1750529343
Name:DR. MELISSA A. BYRAM, LTD.
Entity type:Organization
Organization Name:DR. MELISSA A. BYRAM, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BYRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-352-3555
Mailing Address - Street 1:2435 PYRAMID WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1865
Mailing Address - Country:US
Mailing Address - Phone:775-352-3555
Mailing Address - Fax:775-355-8717
Practice Address - Street 1:2435 PYRAMID WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1865
Practice Address - Country:US
Practice Address - Phone:775-352-3555
Practice Address - Fax:775-355-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20-16556Medicaid