Healthcare Provider Details

I. General information

NPI: 1659064657
Provider Name (Legal Business Name): SYDNI MARIE VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 ROCKSIDE RD
INDEPENDENCE OH
44131-2146
US

IV. Provider business mailing address

12 E EXCHANGE ST # 600
AKRON OH
44308-1519
US

V. Phone/Fax

Practice location:
  • Phone: 234-334-3293
  • Fax:
Mailing address:
  • Phone: 234-334-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: