Healthcare Provider Details

I. General information

NPI: 1316689250
Provider Name (Legal Business Name): FATOUMATA YARIE SYLLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CUMMINGS CTR STE 111W
BEVERLY MA
01915-6183
US

IV. Provider business mailing address

PO BOX 24520
NEW YORK NY
10087-3720
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-1859
  • Fax:
Mailing address:
  • Phone: 781-744-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1022008
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: