Healthcare Provider Details

I. General information

NPI: 1194647149
Provider Name (Legal Business Name): SYDNIE MARIE ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77711 FLORA RD STE 327
PALM DESERT CA
92211-4103
US

IV. Provider business mailing address

74455 JOE DAVIS DR APT 11
TWENTYNINE PALMS CA
92277-2375
US

V. Phone/Fax

Practice location:
  • Phone: 575-263-5592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: