Provider Demographics
NPI:1104460336
Name:MCBRYDE, SYLVANUS BRIAN
Entity type:Individual
Prefix:
First Name:SYLVANUS
Middle Name:BRIAN
Last Name:MCBRYDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:S BRIAN
Other - Middle Name:
Other - Last Name:MCBRYDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3170 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2945
Mailing Address - Country:US
Mailing Address - Phone:419-214-5587
Mailing Address - Fax:567-316-7232
Practice Address - Street 1:3170 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2945
Practice Address - Country:US
Practice Address - Phone:419-214-5587
Practice Address - Fax:567-316-7232
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty