Healthcare Provider Details

I. General information

NPI: 1053224253
Provider Name (Legal Business Name): SYDNEY ROEHM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 ROSS CLARK CIR
DOTHAN AL
36301-3022
US

IV. Provider business mailing address

218 FARM CREEK CT
MIDLAND CITY AL
36350-4091
US

V. Phone/Fax

Practice location:
  • Phone: 251-753-5832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-163081
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: