Provider Demographics
NPI:1770629925
Name:SYLVESTER, BRENDA ANN (RPA-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HARRISON ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2161
Mailing Address - Country:US
Mailing Address - Phone:607-763-8205
Mailing Address - Fax:607-763-8208
Practice Address - Street 1:161 RIVERSIDE DR
Practice Address - Street 2:SUITE M08
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4176
Practice Address - Country:US
Practice Address - Phone:607-763-8205
Practice Address - Fax:607-763-8208
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009616-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDING NPIMedicare UPIN
PENDING NPIMedicare ID - Type Unspecified