Provider Demographics
NPI:1497482616
Name:TERRY, SYLVESTER LEE JR
Entity Type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:LEE
Last Name:TERRY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 CHAFFEE POINT BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-4131
Mailing Address - Country:US
Mailing Address - Phone:904-566-2564
Mailing Address - Fax:
Practice Address - Street 1:514 CHAFFEE POINT BLVD STE 11
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-4131
Practice Address - Country:US
Practice Address - Phone:904-566-2564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA94347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA94347OtherFLORIDA HEALTH DEPARTMENT LICENSE NUMBER