Provider Demographics
NPI:1003695511
Name:SYLVESTRE, SAMUEL
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:SYLVESTRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EMERALD LN
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3214
Mailing Address - Country:US
Mailing Address - Phone:845-405-1845
Mailing Address - Fax:
Practice Address - Street 1:706 EXECUTIVE BLVD STE D
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2039
Practice Address - Country:US
Practice Address - Phone:845-309-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207QA0401X207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine