1982263703 NPI number — SYDNEY BROOKE WINNER

Table of content: SYDNEY BROOKE WINNER (NPI 1982263703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982263703 NPI number — SYDNEY BROOKE WINNER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINNER
Provider First Name:
SYDNEY
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982263703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5350 SHEA ST UNIT 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32814-6918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-790-4811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5350 SHEA ST UNIT 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32814-6918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-790-4811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SZ9029 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SA18262 . This is a "FLORIDA SPEECH LANGUAGE PATHOLOGIST LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: SZ9029 . This is a "FL PROVISIONAL SLP LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 33882 . This is a "CALIFORNIA SPEECH PATHOLOGIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 103211300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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