Healthcare Provider Details

I. General information

NPI: 1760257398
Provider Name (Legal Business Name): SYDNEY HASELDEN CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 STATE ROAD 54
TRINITY FL
34655-1808
US

IV. Provider business mailing address

17436 FOUNTAINSIDE LOOP APT 310
LUTZ FL
33558-5602
US

V. Phone/Fax

Practice location:
  • Phone: 407-408-1156
  • Fax:
Mailing address:
  • Phone: 407-408-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA1000
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: