Provider Demographics
NPI:1043219801
Name:PETERSON, SYLVETTE G (DPM)
Entity Type:Individual
Prefix:DR
First Name:SYLVETTE
Middle Name:G
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0717
Mailing Address - Country:US
Mailing Address - Phone:787-882-4280
Mailing Address - Fax:787-882-4280
Practice Address - Street 1:CARR 107
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5970
Practice Address - Country:US
Practice Address - Phone:787-882-4280
Practice Address - Fax:787-882-4280
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0037213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRT-81945Medicare UPIN
PR0048051Medicare ID - Type Unspecified