Healthcare Provider Details

I. General information

NPI: 1275560047
Provider Name (Legal Business Name): SYDNEY CLEMENTINE BUTTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 5TH AVE FL 3
BROOKLYN NY
11209-5908
US

IV. Provider business mailing address

660 WHITE PLAINS RD STE 400
TARRYTOWN NY
10591-5107
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-0515
  • Fax: 718-745-3436
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number217102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: