Provider Demographics
NPI:1215064027
Name:SMALL-EHILEN, SYLVIA JOAN (CMT)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:JOAN
Last Name:SMALL-EHILEN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 VIRGINIA AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3377
Mailing Address - Country:US
Mailing Address - Phone:202-297-0224
Mailing Address - Fax:301-773-4867
Practice Address - Street 1:4007 34TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1908
Practice Address - Country:US
Practice Address - Phone:202-297-0224
Practice Address - Fax:301-773-4867
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMO1976174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist