Healthcare Provider Details

I. General information

NPI: 1215064027
Provider Name (Legal Business Name): SYLVIA JOAN SMALL-EHILEN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 34TH ST
MOUNT RAINIER MD
20712-1908
US

IV. Provider business mailing address

2406 VIRGINIA AVE APT 103
LANDOVER MD
20785-3377
US

V. Phone/Fax

Practice location:
  • Phone: 202-297-0224
  • Fax: 301-773-4867
Mailing address:
  • Phone: 202-297-0224
  • Fax: 301-773-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMO1976
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: