Provider Demographics
NPI:1972242311
Name:SYLVAIN, CORINE
Entity Type:Individual
Prefix:
First Name:CORINE
Middle Name:
Last Name:SYLVAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 VERNON AVE APT 83
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3648
Mailing Address - Country:US
Mailing Address - Phone:860-849-3090
Mailing Address - Fax:
Practice Address - Street 1:30 AVON MEADOW LN STE 202
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3745
Practice Address - Country:US
Practice Address - Phone:860-284-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist