Provider Demographics
NPI:1184199788
Name:STURDIFEN, SYLEENA SHARLENE (MPA, PA-C)
Entity Type:Individual
Prefix:
First Name:SYLEENA
Middle Name:SHARLENE
Last Name:STURDIFEN
Suffix:
Gender:F
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6401 SEXTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23224-5675
Mailing Address - Country:US
Mailing Address - Phone:804-461-0326
Mailing Address - Fax:
Practice Address - Street 1:2400 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3119
Practice Address - Country:US
Practice Address - Phone:804-264-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-006340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant