Healthcare Provider Details

I. General information

NPI: 1518902840
Provider Name (Legal Business Name): SYLVIA LEE CEREL-SUHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 BURT RD
LEXINGTON KY
40503-2457
US

IV. Provider business mailing address

177 BURT RD
LEXINGTON KY
40503-2457
US

V. Phone/Fax

Practice location:
  • Phone: 859-687-9725
  • Fax:
Mailing address:
  • Phone: 859-687-9725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number28861
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number28861
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number28861
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number28861
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number28861
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: