Provider Demographics
NPI:1811206964
Name:SYLVIA D. CAMPBELL, M.D., P.A.
Entity Type:Organization
Organization Name:SYLVIA D. CAMPBELL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-875-2655
Mailing Address - Street 1:217 SOUTH MATANZAS AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3010
Mailing Address - Country:US
Mailing Address - Phone:813-875-2655
Mailing Address - Fax:813-872-1838
Practice Address - Street 1:217 SOUTH MATANZAS AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3010
Practice Address - Country:US
Practice Address - Phone:813-875-2655
Practice Address - Fax:813-872-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
30483OtherBCBS
FL067048100Medicaid
FL067048100Medicaid
D85542Medicare UPIN