Basic Information
| Provider Information | |||||||||
| NPI: | 1770536898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDMOND | ||||||||
| FirstName: | SYLVIA | ||||||||
| MiddleName: | ADEL | ||||||||
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| NameSuffix: | |||||||||
| Credential: | NPP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COLEBY | ||||||||
| OtherFirstName: | SYLVIA | ||||||||
| OtherMiddleName: | ADEL | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | NPP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1020 MARY ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135011930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157246907 | ||||||||
| FaxNumber: | 3157330791 | ||||||||
| Practice Location | |||||||||
| Address1: | 1427 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135014343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157381428 | ||||||||
| FaxNumber: | 3157381461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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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 | 363LP0808X | 338451-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 01039156 | 05 | NY | MEDICAID | 00474180 | 05 | NY | MEDICAID |