Healthcare Provider Details

I. General information

NPI: 1417440538
Provider Name (Legal Business Name): NYATOU ASTA SYLLA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

1470 RICHMOND TER APT 1B
STATEN ISLAND NY
10310-1109
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number747041-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF432903-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: