Healthcare Provider Details

I. General information

NPI: 1235212846
Provider Name (Legal Business Name): SYBIL PREWITT FAYLO AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 6TH ST S SUITE 170
ST PETERSBURG FL
33701-4827
US

IV. Provider business mailing address

519 31ST AVE N
ST PETERSBURG FL
33704-2134
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8989
  • Fax: 727-767-8998
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: