MEDICARE: DR. SYDNOR A. SIKES PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	21274	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00J74P	OTHER	TX	BLUE CROSS BLUE SHIELD TX

General Provider Information

NPI Number	:	1518018175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYDNOR A. SIKES PH.D.

Provider Business Mailing Address
First Line	:	508 DEEP EDDY AVE
Second Line	:	STE. 3
City	:	AUSTIN
State	:	TX
Zip	:	78703-4555
Country	:	US
Telephone Number	:	512-469-0582
Fax Number	:	512-469-0889

Provider Business Practice Location Address
First Line	:	508 DEEP EDDY AVE
Second Line	:	STE. 3
City	:	AUSTIN
State	:	TX
Zip	:	78703-4555
Country	:	US
Telephone Number	:	512-469-0582
Fax Number	:	512-469-0889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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