Provider Demographics
NPI:1730967753
Name:ANDERSON, SYDNEY T
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:T
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:TOUGALOO
Mailing Address - State:MS
Mailing Address - Zip Code:39174-0452
Mailing Address - Country:US
Mailing Address - Phone:601-573-5442
Mailing Address - Fax:
Practice Address - Street 1:282 E MEADE ST
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3842
Practice Address - Country:US
Practice Address - Phone:601-573-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No376G00000XNursing Service Related ProvidersNursing Home Administrator