MEDICARE: MS. SYLVIA CORSON AHCA PROVIDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion	229170	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	229170	OTHER	FL	AHCA LICENSE NUMBER

General Provider Information

NPI Number	:	1992901516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SYLVIA CORSON AHCA PROVIDER

Provider Business Mailing Address
First Line	:	5100 LAS VERDES CIR
Second Line	:	APT. 114
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8094
Country	:	US
Telephone Number	:	561-495-9671
Fax Number	:	561-495-9671

Provider Business Practice Location Address
First Line	:	5100 LAS VERDES CIR
Second Line	:	APT. 114
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8094
Country	:	US
Telephone Number	:	561-495-9671
Fax Number	:	561-495-9671

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/08/2007

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