=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366636789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYLVAN VALLEY OB/GYN, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2007
-----------------------------------------------------
Last Update Date | 08/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 MEDICAL PARK DR SUITE B
-----------------------------------------------------
City | BREVARD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28712-3874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-884-8860
-----------------------------------------------------
Fax | 828-885-7164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 MEDICAL PARK DR
-----------------------------------------------------
City | BREVARD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28712-3874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-884-8860
-----------------------------------------------------
Fax | 828-885-7164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PARTNER
-----------------------------------------------------
Name | DR. CARMELO ABEL HERNANDEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 828-884-8860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------