Provider Demographics
NPI:1154902880
Name:SYLVESTER, LEAH RAE (MCMSC, PA-C)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:RAE
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:MCMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 6TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4505
Mailing Address - Country:US
Mailing Address - Phone:863-293-2147
Mailing Address - Fax:
Practice Address - Street 1:1450 6TH ST SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4505
Practice Address - Country:US
Practice Address - Phone:863-293-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9114108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant