Provider Demographics
NPI:1336407543
Name:BRANTLEY, SYLVIA
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-3921
Mailing Address - Country:US
Mailing Address - Phone:219-884-2565
Mailing Address - Fax:219-884-2565
Practice Address - Street 1:225 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-3921
Practice Address - Country:US
Practice Address - Phone:219-884-2565
Practice Address - Fax:219-884-2565
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder