Provider Demographics
NPI:1700970308
Name:GOODWIN, SYLVIA TATIANA (MD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:TATIANA
Last Name:GOODWIN
Suffix:
Gender:F
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:PO BOX E
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-0750
Mailing Address - Country:US
Mailing Address - Phone:845-896-9864
Mailing Address - Fax:845-896-4319
Practice Address - Street 1:1089 MAIN STRE
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-0750
Practice Address - Country:US
Practice Address - Phone:845-896-9864
Practice Address - Fax:845-896-9864
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232518207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27198Medicare ID - Type Unspecified
NYG04608Medicare UPIN