Provider Demographics
NPI:1629007224
Name:KING, SYLLETTE N (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLLETTE
Middle Name:N
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S CHICKASAW TRL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7804
Mailing Address - Country:US
Mailing Address - Phone:407-282-8775
Mailing Address - Fax:407-282-0886
Practice Address - Street 1:506 S CHICKASAW TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7804
Practice Address - Country:US
Practice Address - Phone:407-282-8775
Practice Address - Fax:407-282-0886
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69026207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252007900Medicaid
FL252007900Medicaid
FLG16385Medicare UPIN