Provider Demographics
NPI:1538729702
Name:SYDNEY, NAOMI MARA (APRN)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:MARA
Last Name:SYDNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-2433
Mailing Address - Country:US
Mailing Address - Phone:860-816-6060
Mailing Address - Fax:
Practice Address - Street 1:1030 BOULEVARD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1801
Practice Address - Country:US
Practice Address - Phone:860-986-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily