Healthcare Provider Details

I. General information

NPI: 1417918731
Provider Name (Legal Business Name): ROBERT BRIAN SIDELL PYS.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 HAMMERSTONE CIR
WHISPERING PINES NC
28327-6102
US

IV. Provider business mailing address

118 HAMMERSTONE CIR
WHISPERING PINES NC
28327-6102
US

V. Phone/Fax

Practice location:
  • Phone: 254-371-3251
  • Fax:
Mailing address:
  • Phone: 254-371-3251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6579
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.006973
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: