Provider Demographics
NPI:1699930115
Name:HALEY, SYLVIA VICTORIA
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:VICTORIA
Last Name:HALEY
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 1:7501 LYNCREST ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-5535
Mailing Address - Country:US
Mailing Address - Phone:941-423-9836
Mailing Address - Fax:
Practice Address - Street 1:7501 LYNCREST ST
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-5535
Practice Address - Country:US
Practice Address - Phone:941-423-9836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906057372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142814400Medicaid