Provider Demographics
NPI:1386187136
Name:SYLVE, DESTINY ROSE (LAT, ATC, EMT)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:ROSE
Last Name:SYLVE
Suffix:
Gender:F
Credentials:LAT, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35677 HIGHWAY 11 APT B1
Mailing Address - Street 2:
Mailing Address - City:BURAS
Mailing Address - State:LA
Mailing Address - Zip Code:70041-5247
Mailing Address - Country:US
Mailing Address - Phone:985-628-2899
Mailing Address - Fax:
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5798
Practice Address - Country:US
Practice Address - Phone:504-899-3496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3055312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty