Basic Information
| Provider Information | |||||||||
| NPI: | 1912097395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYLVESTER | ||||||||
| FirstName: | VIDYA | ||||||||
| MiddleName: | KESAVAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 WOODLAND ST | ||||||||
| Address2: | CANCER CENTER | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607145554 | ||||||||
| FaxNumber: | 8607148047 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 WOODLAND ST | ||||||||
| Address2: | CANCER CENTER | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607145554 | ||||||||
| FaxNumber: | 8607148047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 003731 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 30343315 | 05 | NH | MEDICAID | 1011074 | 05 | VT | MEDICAID |