Provider Demographics
NPI:1285007443
Name:SYLVINA, LAUREN M (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:SYLVINA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SUNRISE VALLEY DRIVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191
Mailing Address - Country:US
Mailing Address - Phone:703-709-1114
Mailing Address - Fax:703-709-1117
Practice Address - Street 1:11800 SUNRISE VALLEY DRIVE
Practice Address - Street 2:SUITE 800
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:703-709-1114
Practice Address - Fax:703-709-1117
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0001039363A00000X
PAOA003704363A00000X
NJ25MP00399200363A00000X
PAMA057994363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA466688P4RMedicare PIN
DE466666CB4Medicare PIN