Healthcare Provider Details

I. General information

NPI: 1275601734
Provider Name (Legal Business Name): KATI S SYLVESTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 STATION AVE STE 102
BRUNSWICK ME
04011-2092
US

IV. Provider business mailing address

22 STATION AVE STE 102
BRUNSWICK ME
04011-2092
US

V. Phone/Fax

Practice location:
  • Phone: 207-406-7500
  • Fax: 207-618-5674
Mailing address:
  • Phone: 207-406-7500
  • Fax: 207-618-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2611
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001865
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001865
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: