Healthcare Provider Details

I. General information

NPI: 1487329090
Provider Name (Legal Business Name): SYLVANUS GWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 TWIN OAK CT
LANHAM MD
20706-1935
US

IV. Provider business mailing address

4402 TWIN OAK CT
LANHAM MD
20706-1935
US

V. Phone/Fax

Practice location:
  • Phone: 240-714-9077
  • Fax:
Mailing address:
  • Phone: 240-714-9077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: