Provider Demographics
NPI:1417711029
Name:SYLVESTER, TALIA
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15058 50TH ST NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-1707
Mailing Address - Country:US
Mailing Address - Phone:763-331-4256
Mailing Address - Fax:
Practice Address - Street 1:15058 50TH ST NE
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-1707
Practice Address - Country:US
Practice Address - Phone:763-331-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant