Healthcare Provider Details

I. General information

NPI: 1467030460
Provider Name (Legal Business Name): SYDNEY STROUD LASSITER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. SYDNEY BLAIR STROUD

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3204 ARCHDALE RD
ARCHDALE NC
27263-2710
US

IV. Provider business mailing address

3204 ARCHDALE RD
ARCHDALE NC
27263-2710
US

V. Phone/Fax

Practice location:
  • Phone: 336-434-2107
  • Fax: 336-434-2109
Mailing address:
  • Phone: 336-434-2107
  • Fax: 336-434-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5304
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: