Provider Demographics
NPI:1710124342
Name:GILYARD, LYNN (TVI)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:GILYARD
Suffix:
Gender:F
Credentials:TVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 PRESCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2148
Mailing Address - Country:US
Mailing Address - Phone:607-754-5811
Mailing Address - Fax:
Practice Address - Street 1:711 PRESCOTT AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-2148
Practice Address - Country:US
Practice Address - Phone:607-754-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY69608371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist