Provider Demographics
NPI:1679813695
Name:SYLVESTSER, COLLEEN A (RD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:SYLVESTSER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 GATE HOUSE PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2601
Mailing Address - Country:US
Mailing Address - Phone:804-364-6066
Mailing Address - Fax:
Practice Address - Street 1:10030 ROBIOUS RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4818
Practice Address - Country:US
Practice Address - Phone:804-212-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA384346133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered