Healthcare Provider Details

I. General information

NPI: 1407958028
Provider Name (Legal Business Name): SIDNEY ROSE ORNDUFF PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

7556 US HIGHWAY 70
BARTLETT TN
38133-2686
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax: 901-577-7467
Mailing address:
  • Phone: 901-552-3497
  • Fax: 574-635-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2376
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: