Provider Demographics
NPI:1063246882
Name:FANDOHAN, SYLVIE A
Entity type:Individual
Prefix:
First Name:SYLVIE
Middle Name:A
Last Name:FANDOHAN
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 1:131 PLANTATION RIDGE DR STE 305
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9543
Mailing Address - Country:US
Mailing Address - Phone:828-540-0112
Mailing Address - Fax:
Practice Address - Street 1:131 PLANTATION RIDGE DR STE 305
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9543
Practice Address - Country:US
Practice Address - Phone:828-540-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC7552253Z00000X, 385H00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care