1447672654 NPI number — SHARNEQUE ANASTACIA SYLVESTER LPN

Table of content: SHARNEQUE ANASTACIA SYLVESTER LPN (NPI 1447672654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447672654 NPI number — SHARNEQUE ANASTACIA SYLVESTER LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYLVESTER
Provider First Name:
SHARNEQUE
Provider Middle Name:
ANASTACIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SYLVESTER
Provider Other First Name:
ANASTACIA
Provider Other Middle Name:
SHARNEQUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447672654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2722 CONCORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST MEADOW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11554-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-930-3943
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2052 TILLOTSON AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10475-1560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-671-2100
Provider Business Practice Location Address Fax Number:
347-964-0790
Provider Enumeration Date:
01/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  317152 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WG0000X , with the licence number: 763044 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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