Provider Demographics
NPI:1477710960
Name:SYLVIA, MARY BETH (RN,MS,FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:SYLVIA
Suffix:
Gender:F
Credentials:RN,MS,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:VASCULAR ANOMALIES CENTER, CHILDREN'S HOSPITAL BOSTON
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-5226
Mailing Address - Fax:617-730-0752
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:VASCULAR ANOMALIES CENTER, CHILDREN'S HOSPITAL BOSTON
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-5226
Practice Address - Fax:617-730-0752
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2694OtherBCBSMA
MASYNP2694OtherMEDICARE
MA0354350Medicaid
MASYNP2694OtherMEDICARE