Healthcare Provider Details

I. General information

NPI: 1629326293
Provider Name (Legal Business Name): GREGORY ALEXANDER SYLVIA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 SE US HIGHWAY 19
CRYSTAL RIVER FL
34429-4849
US

IV. Provider business mailing address

5400 PINEHURST DR
SPRING HILL FL
34606-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-699-2040
  • Fax:
Mailing address:
  • Phone: 352-277-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: