Provider Demographics
NPI:1538770433
Name:ELLSWORTH, SYLVIA M
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:M
Last Name:ELLSWORTH
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 1:151 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-4561
Mailing Address - Country:US
Mailing Address - Phone:540-535-6417
Mailing Address - Fax:
Practice Address - Street 1:151 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443-4561
Practice Address - Country:US
Practice Address - Phone:540-535-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant