Provider Demographics
NPI:1184612798
Name:SYLVESTER, STEPHEN D (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:D
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-1120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RU STATION 6899
Practice Address - Street 2:ADAMS & TYLER STREETS
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24142
Practice Address - Country:US
Practice Address - Phone:540-831-6667
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001460OtherVA BOARD OF MEDICINE