Healthcare Provider Details

I. General information

NPI: 1134083439
Provider Name (Legal Business Name): SYDNEY GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 99TH AVE N
NAPLES FL
34108-2234
US

IV. Provider business mailing address

5981 ASHFORD LN
NAPLES FL
34110-2396
US

V. Phone/Fax

Practice location:
  • Phone: 239-392-1070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT22232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: