Provider Demographics
NPI:1205292760
Name:SYLVIA, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SYLVIA
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 1:375 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1109
Mailing Address - Country:US
Mailing Address - Phone:917-886-5910
Mailing Address - Fax:
Practice Address - Street 1:375 ELM AVE
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1109
Practice Address - Country:US
Practice Address - Phone:917-886-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00047400231H00000X
NY001174-1231H00000X
NY025352-1235Z00000X
NJ41YS00507000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist