Provider Demographics
NPI:1891059838
Name:SYLLA, MOHAMED
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:
Last Name:SYLLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6864
Mailing Address - Country:US
Mailing Address - Phone:202-491-5726
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVE NW # 307A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2165
Practice Address - Country:US
Practice Address - Phone:202-450-3108
Practice Address - Fax:202-450-3109
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide