Provider Demographics
NPI:1629431515
Name:SYLLA, MATIDA
Entity Type:Individual
Prefix:
First Name:MATIDA
Middle Name:
Last Name:SYLLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MATIDA
Other - Middle Name:
Other - Last Name:SYLLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED NURSE ASSI
Mailing Address - Street 1:1365 SHERIDAN AVE
Mailing Address - Street 2:APT 2G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-8100
Mailing Address - Country:US
Mailing Address - Phone:718-947-6812
Mailing Address - Fax:
Practice Address - Street 1:1365 SHERIDAN AVE
Practice Address - Street 2:APT 2G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-8100
Practice Address - Country:US
Practice Address - Phone:718-947-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343798350316E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide