Provider Demographics
NPI:1538779657
Name:CONSTANTE, SYDNEY CHRISTINE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CHRISTINE
Last Name:CONSTANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:CHRISTINE
Other - Last Name:WERGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1 FORD PLACE STE 3A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-1842
Mailing Address - Country:US
Mailing Address - Phone:313-874-4553
Mailing Address - Fax:
Practice Address - Street 1:6777 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3013
Practice Address - Country:US
Practice Address - Phone:248-661-6425
Practice Address - Fax:248-325-0094
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704362648367A00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife