Provider Demographics
NPI:1679709877
Name:BRODHEAD, SYLVIA B (RN)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:B
Last Name:BRODHEAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SYLVIA
Other - Middle Name:C
Other - Last Name:BAINGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE TECHNICIAN
Mailing Address - Street 1:2277 OSBORNE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037
Mailing Address - Country:US
Mailing Address - Phone:315-687-5187
Mailing Address - Fax:
Practice Address - Street 1:2277 OSBORNE ROAD
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037
Practice Address - Country:US
Practice Address - Phone:315-687-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY476963-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse