Provider Demographics
NPI:1144006156
Name:WHITEHEAD, SYDNEY (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3224
Mailing Address - Country:US
Mailing Address - Phone:256-856-4544
Mailing Address - Fax:
Practice Address - Street 1:1118 22ND AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3224
Practice Address - Country:US
Practice Address - Phone:256-856-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered