Healthcare Provider Details

I. General information

NPI: 1760407563
Provider Name (Legal Business Name): LISA E SYLVESTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33100 CLEVELAND CLINIC BLVD
AVON OH
44011-1390
US

IV. Provider business mailing address

9500 EUCLID AVE E19
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 800-272-2676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3720
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number012206
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: