Healthcare Provider Details

I. General information

NPI: 1558087940
Provider Name (Legal Business Name): SYNDICATE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N 2ND ST APT 131
SAN JOSE CA
95112-4096
US

IV. Provider business mailing address

1720 JASPER HIGHLANDS DR
MORGAN HILL CA
95037-9164
US

V. Phone/Fax

Practice location:
  • Phone: 408-740-5565
  • Fax:
Mailing address:
  • Phone: 408-740-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. SHANNON SEVOR
Title or Position: CEO
Credential:
Phone: 408-740-5565