Provider Demographics
NPI:1326419094
Name:BOGNAR, SYLVIA (LAC)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:BOGNAR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8991 DEER HILL RD
Mailing Address - Street 2:
Mailing Address - City:BELEWS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27009-9768
Mailing Address - Country:US
Mailing Address - Phone:336-602-9012
Mailing Address - Fax:
Practice Address - Street 1:2512 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4618
Practice Address - Country:US
Practice Address - Phone:336-306-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16741171100000X
NC864171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist