Healthcare Provider Details

I. General information

NPI: 1982509931
Provider Name (Legal Business Name): SYDNEY GAMBELIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S 55TH ST APT A218
ROGERS AR
72758-4342
US

IV. Provider business mailing address

2701 S 55TH ST APT A218
ROGERS AR
72758-4342
US

V. Phone/Fax

Practice location:
  • Phone: 408-410-8594
  • Fax:
Mailing address:
  • Phone: 408-410-8594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3235
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: