Healthcare Provider Details

I. General information

NPI: 1942553110
Provider Name (Legal Business Name): STEPHANIE ANN SYLVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SMITH NECK RD
DARTMOUTH MA
02748-1502
US

IV. Provider business mailing address

620 SMITH NECK RD
DARTMOUTH MA
02748-1502
US

V. Phone/Fax

Practice location:
  • Phone: 774-451-1613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN588417
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2278681
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: