Individual provider Active NPI

Misheda Davora Mylesdavis, NURSE PRACTITIONER

  • Nurse Practitioner
  • Riverside, CA
National Provider Identifier
1851685101
Registry record updated May 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95038183 Issued in CA
Practice address
4020 Chicago Ave # 2093
Riverside, CA 92507-5340
Phone
(951) 546-2578
NPI assigned
Jun 3, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X 95038183 CA Primary

Addresses

Primary practice location

4020 Chicago Ave # 2093
Riverside, CA 92507-5340

Mailing address

4020 Chicago Ave # 2093
Riverside, CA 92507-5340
Phone (951) 546-2578

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260526001096 CA Practitioner - Nurse Practitioner 5294205845 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11103 Venice Blvd
Los Angeles, CA 90034-6914

14525 Valley View Ave
Suite E
Santa Fe Springs, CA 90670-5237

91 Zinnia St
Ladera Ranch, CA 92694-0888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95038183CAMDNurse Practitioner

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779235200000",
    "number": "1851685101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 CHICAGO AVE # 2093",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925075340",
            "telephone_number": "951-546-2578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 CHICAGO AVE # 2093",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925075340",
            "telephone_number": "951-546-2578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYLESDAVIS",
        "first_name": "MISHEDA",
        "middle_name": "DAVORA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-03",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95038183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.