Basic Information
| Provider Information | |||||||||
| NPI: | 1184975195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOB TANEMOSSU | ||||||||
| FirstName: | SYLVAIN VALERE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11548 FEBRUARY CIR | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209046930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024039356 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11700 OLD COLUMBIA PIKE APT 1812 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209042558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025450935 | ||||||||
| FaxNumber: | 2025450176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2012 | ||||||||
| LastUpdateDate: | 07/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374U00000X | N | Nursing Service Related Providers | Home Health Aide | 183500000X | 26782 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.