Healthcare Provider Details

I. General information

NPI: 1821862673
Provider Name (Legal Business Name): ANNE DYKEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA SIDORENKO

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 THREE ISLANDS BLVD APT 411
HALLANDALE BEACH FL
33009-2847
US

IV. Provider business mailing address

601 THREE ISLANDS BLVD APT 411
HALLANDALE BEACH FL
33009-2847
US

V. Phone/Fax

Practice location:
  • Phone: 785-375-5992
  • Fax:
Mailing address:
  • Phone: 785-375-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: