Healthcare Provider Details

I. General information

NPI: 1467277376
Provider Name (Legal Business Name): SYLVESTER NDIFOR APNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 QUARRY PARK RD
MADISON WI
53718-7901
US

IV. Provider business mailing address

2500 W LAYTON AVE STE 110
MILWAUKEE WI
53221-5400
US

V. Phone/Fax

Practice location:
  • Phone: 844-767-3769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number16186-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: