Provider Demographics
NPI:1861844367
Name:SYLVIA WYNNE, JACQULYNE HELENE
Entity type:Individual
Prefix:
First Name:JACQULYNE
Middle Name:HELENE
Last Name:SYLVIA WYNNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQULYNE
Other - Middle Name:HELENE
Other - Last Name:SYLVIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:965 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-2530
Practice Address - Country:US
Practice Address - Phone:916-642-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19051207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology