Healthcare Provider Details

I. General information

NPI: 1174453724
Provider Name (Legal Business Name): DR. ANTHONY SILLEMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N CARPENTER RD STE D49
MODESTO CA
95351-1188
US

IV. Provider business mailing address

1620 N CARPENTER RD STE D49
MODESTO CA
95351-1188
US

V. Phone/Fax

Practice location:
  • Phone: 209-531-3217
  • Fax: 209-526-3617
Mailing address:
  • Phone: 209-531-3217
  • Fax: 209-526-3617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: