Provider Demographics
NPI:1194774513
Name:CAMPBELL, SYLVIA D (MD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:D
Last Name:CAMPBELL
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 1:217 S MATANZAS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3010
Mailing Address - Country:US
Mailing Address - Phone:813-875-2655
Mailing Address - Fax:813-872-1838
Practice Address - Street 1:217 S MATANZAS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3010
Practice Address - Country:US
Practice Address - Phone:813-875-2655
Practice Address - Fax:813-872-1838
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067048100Medicaid
020001834OtherRR MCR ID #
33660OtherGHI ID #
DC30483OtherBCBS ID #
592316341OtherFEDERAL TAX ID
592316341OtherFEDERAL TAX ID
020001834OtherRR MCR ID #
DC30483OtherBCBS ID #