Provider Demographics
NPI:1902229974
Name:STATEN, SYLVESTER T
Entity Type:Individual
Prefix:DR
First Name:SYLVESTER
Middle Name:T
Last Name:STATEN
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 1:3890 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3319
Mailing Address - Country:US
Mailing Address - Phone:754-779-7429
Mailing Address - Fax:754-265-7055
Practice Address - Street 1:3890 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33309-3319
Practice Address - Country:US
Practice Address - Phone:754-779-7429
Practice Address - Fax:754-265-7055
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP1600X101YP1600X
FL1400011427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral