Provider Demographics
NPI:1497115687
Name:LORA, SYLVANA (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:SYLVANA
Middle Name:
Last Name:LORA
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PARSONS AVE # 2
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2506
Mailing Address - Country:US
Mailing Address - Phone:516-359-0905
Mailing Address - Fax:
Practice Address - Street 1:53 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3709
Practice Address - Country:US
Practice Address - Phone:516-442-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019549363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant