Provider Demographics
NPI:1962103895
Name:SYLLA, MMAHAWA
Entity type:Individual
Prefix:MISS
First Name:MMAHAWA
Middle Name:
Last Name:SYLLA
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 1:55 WESTCHESTER SQ
Mailing Address - Street 2:C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3525
Mailing Address - Country:US
Mailing Address - Phone:718-931-4045
Mailing Address - Fax:718-884-8096
Practice Address - Street 1:55 WESTCHESTER SQ
Practice Address - Street 2:C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3525
Practice Address - Country:US
Practice Address - Phone:718-931-4045
Practice Address - Fax:718-884-8096
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty