Healthcare Provider Details

I. General information

NPI: 1568130029
Provider Name (Legal Business Name): SYDNEY TAMARA POLLOCK MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 NE 4TH AVE
FORT LAUDERDALE FL
33304-1035
US

IV. Provider business mailing address

5900 SW 24TH PL APT 307
DAVIE FL
33314-1145
US

V. Phone/Fax

Practice location:
  • Phone: 954-835-5741
  • Fax:
Mailing address:
  • Phone: 407-615-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: