Provider Demographics
NPI:1275392219
Name:SYRABELL LLC
Entity Type:Organization
Organization Name:SYRABELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:BASIRATU
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:202-221-1234
Mailing Address - Street 1:9079 FOX STREAM WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2557
Mailing Address - Country:US
Mailing Address - Phone:202-221-1234
Mailing Address - Fax:
Practice Address - Street 1:9079 FOX STREAM WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2557
Practice Address - Country:US
Practice Address - Phone:202-221-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty