Provider Demographics
NPI:1790891844
Name:ANDERSON, SYLVIA M (MD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:M
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 OAK STREET
Mailing Address - Street 2:
Mailing Address - City:FAULKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57438-0100
Mailing Address - Country:US
Mailing Address - Phone:605-598-6262
Mailing Address - Fax:605-598-4199
Practice Address - Street 1:1300 OAK STREET
Practice Address - Street 2:
Practice Address - City:FAULKTON
Practice Address - State:SD
Practice Address - Zip Code:57438-0100
Practice Address - Country:US
Practice Address - Phone:605-598-6262
Practice Address - Fax:605-598-4199
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5611890Medicaid
SD5882OtherSD STATE BOARD OF MEDICAL
ND9764OtherNEW GRADUATE
ND13160Medicaid
SD5882OtherSD STATE BOARD OF MEDICAL
ND24729Medicare ID - Type Unspecified
SD101137Medicare ID - Type UnspecifiedPART B
ND13160Medicaid