Healthcare Provider Details

I. General information

NPI: 1689369613
Provider Name (Legal Business Name): SYDNEY LESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 SOUTHPOINT PKWY STE 500
JACKSONVILLE FL
32216-1702
US

IV. Provider business mailing address

12 MORTON DR
LAGRANGE GA
30240-3967
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-1208
  • Fax: 706-221-1209
Mailing address:
  • Phone: 706-350-3263
  • 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: