Provider Demographics
NPI:1336399344
Name:SYLVESTER, MARK EINAR (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EINAR
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 VENTURE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5130
Mailing Address - Country:US
Mailing Address - Phone:941-363-0878
Mailing Address - Fax:941-363-0527
Practice Address - Street 1:6320 VENTURE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5130
Practice Address - Country:US
Practice Address - Phone:941-363-0878
Practice Address - Fax:941-363-0527
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN-131652084P0800X
FLME1069572084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry