Provider Demographics
NPI:1891097663
Name:JOHNSON, SYLVIA BUDD (MD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:BUDD
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SYLVIA
Other - Middle Name:LENIECE
Other - Last Name:BUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10437 MOSS PARK RD STE B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5812
Mailing Address - Country:US
Mailing Address - Phone:407-808-5773
Mailing Address - Fax:
Practice Address - Street 1:10437 MOSS PARK RD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5812
Practice Address - Country:US
Practice Address - Phone:407-808-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 157182084P0804X
HIMD15718208D00000X
FLME1339852084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN