Healthcare Provider Details

I. General information

NPI: 1356936496
Provider Name (Legal Business Name): SYDNEY MOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 02/17/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 HIGHWAY 90
PACE FL
32571-1529
US

IV. Provider business mailing address

5345 HIGHWAY 90
PACE FL
32571-1529
US

V. Phone/Fax

Practice location:
  • Phone: 850-463-4999
  • Fax: 850-361-3443
Mailing address:
  • Phone: 850-626-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-157859
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-157859
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: