Healthcare Provider Details

I. General information

NPI: 1174164339
Provider Name (Legal Business Name): EMMA FAYE SYBERT RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E VINE ST
SALISBURY MD
21804-5531
US

IV. Provider business mailing address

504 BARWICK CT
BEL AIR MD
21014-5203
US

V. Phone/Fax

Practice location:
  • Phone: 443-987-2230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86143846
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: