Provider Demographics
NPI:1164553319
Name:KNOWLTON, SYLVIA KELLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:KELLEY
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:MD
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 64
Mailing Address - Street 2:
Mailing Address - City:ALFRED STATION
Mailing Address - State:NY
Mailing Address - Zip Code:14803-0064
Mailing Address - Country:US
Mailing Address - Phone:607-587-9008
Mailing Address - Fax:
Practice Address - Street 1:1549 WATERWELLS RD
Practice Address - Street 2:
Practice Address - City:ALFRED STATION
Practice Address - State:NY
Practice Address - Zip Code:14803-9794
Practice Address - Country:US
Practice Address - Phone:607-587-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34668207RA0201X
WY2722A207RA0201X
IN01026292A207RA0201X
NY193544207RA0201X
CO21239207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD62977Medicare UPIN