Provider Demographics
NPI:1538183264
Name:PARK, SYLVIA WOO (MD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:WOO
Last Name:PARK
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 1:2400 S CLINTON AVE STE G2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2636
Mailing Address - Country:US
Mailing Address - Phone:585-341-7685
Mailing Address - Fax:
Practice Address - Street 1:2400 S CLINTON AVE STE G2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2636
Practice Address - Country:US
Practice Address - Phone:585-341-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101263BJOtherPREFERRED CARE
NYP010201380OtherBLUE CHOICE
NY01748223Medicaid
NY7853060OtherAETNA
NY0357OtherBCBS
NY34613IMedicare ID - Type Unspecified
NYP010201380OtherBLUE CHOICE