Provider Demographics
NPI:1689351231
Name:SYLVESTER, MACKENZI K (IBCLC)
Entity Type:Individual
Prefix:
First Name:MACKENZI
Middle Name:K
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:MACKENZI
Other - Middle Name:K
Other - Last Name:PRESTRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:308 S POPLAR CT
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-1000
Mailing Address - Country:US
Mailing Address - Phone:812-929-3685
Mailing Address - Fax:
Practice Address - Street 1:308 S POPLAR CT
Practice Address - Street 2:
Practice Address - City:ELLETTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47429-1000
Practice Address - Country:US
Practice Address - Phone:812-929-3685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INL-306278174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN