Provider Demographics
NPI:1558823807
Name:CANALES, SYBIL (FNP)
Entity Type:Individual
Prefix:
First Name:SYBIL
Middle Name:
Last Name:CANALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 OXON HILL RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744
Mailing Address - Country:US
Mailing Address - Phone:443-431-4403
Mailing Address - Fax:
Practice Address - Street 1:8507 OXON HILL RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744
Practice Address - Country:US
Practice Address - Phone:443-431-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2020-11-03
Deactivation Date:2019-05-04
Deactivation Code:
Reactivation Date:2020-10-30
Provider Licenses
StateLicense IDTaxonomies
MDF03190812363LF0000X
MDR174153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily