Healthcare Provider Details

I. General information

NPI: 1679741961
Provider Name (Legal Business Name): SYBIL ANN ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. ARMY CLINIC BUILDING 8740-8742
BAUMHOLDER GERMANY
55774
DE

IV. Provider business mailing address

CMR 405 BOX 1356
APO AE
09034-0014
US

V. Phone/Fax

Practice location:
  • Phone: 049678368813
  • Fax:
Mailing address:
  • Phone: 315-351-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number175519-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: