Healthcare Provider Details

I. General information

NPI: 1871724112
Provider Name (Legal Business Name): AMARA SYLLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4523 SUNNINGDALE AVE NE
ALBUQUERQUE NM
87110-5750
US

IV. Provider business mailing address

12224 VICTORIA FALLS DR NE
ALBUQUERQUE NM
87111-5437
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-3915
  • Fax:
Mailing address:
  • Phone: 505-261-2129
  • 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: