Healthcare Provider Details

I. General information

NPI: 1669235420
Provider Name (Legal Business Name): SYDNEY CHRISTINE TAKATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 FERGUSON DR
CINCINNATI OH
45245-5136
US

IV. Provider business mailing address

6369 RIDGELINE DR
COLD SPRING KY
41076-9302
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-2663
  • Fax:
Mailing address:
  • Phone: 773-706-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-5703
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT007238
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126003785
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: