MEDICARE: DR. SYLVIA BUDD JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	MD 15718	HI
2	208D00000X	General Practice Physician	MD15718	HI
3	2084P0804X	Child & Adolescent Psychiatry Physician	ME133985	FL

General Provider Information

NPI Number	:	1891097663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYLVIA BUDD JOHNSON M.D.

Provider Business Mailing Address
First Line	:	10437 MOSS PARK RD STE B
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-5812
Country	:	US
Telephone Number	:	407-808-5773
Fax Number	:

Provider Business Practice Location Address
First Line	:	10437 MOSS PARK RD STE B
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-5812
Country	:	US
Telephone Number	:	407-808-5773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2010
Last Update Date	:	07/25/2019

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