=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992135305
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW SLYE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2013
-----------------------------------------------------
Last Update Date | 01/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 JARRETT WHITE RD
-----------------------------------------------------
City | TRIPLER AMC
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96859-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-433-9239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1706 T ST NW APT 202
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20009-7192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-840-7043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 1321
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------