Provider Demographics
NPI:1578102182
Name:SYLLA, IANIE PHILLIPA
Entity Type:Individual
Prefix:
First Name:IANIE
Middle Name:PHILLIPA
Last Name:SYLLA
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 1:9101 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1108
Mailing Address - Country:US
Mailing Address - Phone:215-528-7541
Mailing Address - Fax:
Practice Address - Street 1:9101 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1108
Practice Address - Country:US
Practice Address - Phone:215-528-7541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA42873601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA42873601OtherPA DEPARTMENT OF HEALTH