Provider Demographics
NPI:1265193304
Name:SYLVESTER, SHARON MARIE (ETC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-9027
Mailing Address - Country:US
Mailing Address - Phone:802-222-5332
Mailing Address - Fax:
Practice Address - Street 1:70 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-9027
Practice Address - Country:US
Practice Address - Phone:802-222-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0194311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047W064Medicaid