Provider Demographics
NPI:1609211747
Name:SYLVAS, NICHOLAS BERNARD
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BERNARD
Last Name:SYLVAS
Suffix:
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 1:2152 JEREMIAH WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-3718
Mailing Address - Country:US
Mailing Address - Phone:407-348-6574
Mailing Address - Fax:
Practice Address - Street 1:668 N ORLANDO AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4473
Practice Address - Country:US
Practice Address - Phone:407-215-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLISW35891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health