Healthcare Provider Details

I. General information

NPI: 1720627706
Provider Name (Legal Business Name): SYDNEY REESE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5953 SW GAINES AVE
STUART FL
34997-7460
US

IV. Provider business mailing address

5953 SW GAINES AVE
STUART FL
34997-7460
US

V. Phone/Fax

Practice location:
  • Phone: 305-803-7358
  • Fax:
Mailing address:
  • Phone: 305-803-7358
  • 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: