Provider Demographics
NPI:1851461578
Name:SYLVESTER, S. RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:S.
Middle Name:RUSSELL
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:P.O. BOX 221
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1131
Mailing Address - Country:US
Mailing Address - Phone:860-673-6124
Mailing Address - Fax:860-673-3290
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1131
Practice Address - Country:US
Practice Address - Phone:860-673-6124
Practice Address - Fax:860-673-3290
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18070208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics