Basic Information
| Provider Information | |||||||||
| NPI: | 1801122478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRACZYK | ||||||||
| FirstName: | SYLWIA | ||||||||
| MiddleName: | ANGELICA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 861 CORONADO CENTER DR STE 211 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890523992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024078241 | ||||||||
| FaxNumber: | 7024921728 | ||||||||
| Practice Location | |||||||||
| Address1: | 7391 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891171577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023042144 | ||||||||
| FaxNumber: | 7023042147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2009 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA054215 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | PA1285 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1801122478 | 05 | NV | MEDICAID |