Healthcare Provider Details

I. General information

NPI: 1386584977
Provider Name (Legal Business Name): SYDNEY MARIE RUSSELL MPH, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 S RACCOON RD
CANFIELD OH
44406-8171
US

IV. Provider business mailing address

4813 SHIELDS RD
CANFIELD OH
44406-9521
US

V. Phone/Fax

Practice location:
  • Phone: 330-727-0175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number11510
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: