Healthcare Provider Details

I. General information

NPI: 1568187599
Provider Name (Legal Business Name): SYLVIE M SHIWIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 ALCOVY ST STE B5
MONROE GA
30655-2184
US

IV. Provider business mailing address

2839 HERITAGE OAKS CIR
DACULA GA
30019-7082
US

V. Phone/Fax

Practice location:
  • Phone: 678-520-4173
  • Fax:
Mailing address:
  • Phone: 678-520-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN245344
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN245344
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: