Provider Demographics
NPI:1043993835
Name:GRANT, SYLVESTER JR
Entity Type:Individual
Prefix:MR
First Name:SYLVESTER
Middle Name:
Last Name:GRANT
Suffix:JR
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 1:4905 S KATHY DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-2215
Mailing Address - Country:US
Mailing Address - Phone:580-704-8995
Mailing Address - Fax:
Practice Address - Street 1:4905 S KATHY DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-2215
Practice Address - Country:US
Practice Address - Phone:580-704-8995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator