Healthcare Provider Details

I. General information

NPI: 1023690880
Provider Name (Legal Business Name): SYDNEY MAIRE FEESER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7254 CHATEAUROUX DR APT A
DAYTON OH
45459-5377
US

IV. Provider business mailing address

7254 CHATEAUROUX DR APT A
DAYTON OH
45459-5377
US

V. Phone/Fax

Practice location:
  • Phone: 937-825-7439
  • Fax:
Mailing address:
  • Phone: 937-825-7439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: