Healthcare Provider Details

I. General information

NPI: 1558211490
Provider Name (Legal Business Name): SYDNEY CASSANDRA CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 BOSQUE RD
ALGODONES NM
87001-8014
US

IV. Provider business mailing address

P.O. BOX 4339
SAN FELIPE PUEBLO NM
87001
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-8787
  • Fax:
Mailing address:
  • Phone: 505-908-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: