Healthcare Provider Details

I. General information

NPI: 1164553319
Provider Name (Legal Business Name): SYLVIA KELLEY KNOWLTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 WATERWELLS RD
ALFRED STATION NY
14803-9794
US

IV. Provider business mailing address

PO BOX 64
ALFRED STATION NY
14803-0064
US

V. Phone/Fax

Practice location:
  • Phone: 607-587-9008
  • Fax:
Mailing address:
  • Phone: 607-587-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberME34668
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number2722A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number01026292A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number193544
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number21239
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: