Provider Demographics
NPI:1649528829
Name:BLYTH, SYLVIA DAVIS (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:DAVIS
Last Name:BLYTH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 OAKLANDING RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3829
Mailing Address - Country:US
Mailing Address - Phone:843-670-1488
Mailing Address - Fax:
Practice Address - Street 1:1452 OAKLANDING RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3829
Practice Address - Country:US
Practice Address - Phone:843-670-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC300133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered