Provider Demographics
NPI:1619390374
Name:SYLLA, FARID MOHAMED
Entity Type:Individual
Prefix:
First Name:FARID
Middle Name:MOHAMED
Last Name:SYLLA
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 1:711 HUDSON AV APT 7
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912
Mailing Address - Country:US
Mailing Address - Phone:936-777-1535
Mailing Address - Fax:
Practice Address - Street 1:711 HUDSON AVE APT 7
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6864
Practice Address - Country:US
Practice Address - Phone:936-777-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide