Healthcare Provider Details

I. General information

NPI: 1548257371
Provider Name (Legal Business Name): LYDA SWEENEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST STE 300
AUSTIN TX
78705-1000
US

IV. Provider business mailing address

1301 W 38TH ST STE 300
AUSTIN TX
78705-1000
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-5721
  • Fax: 512-454-2801
Mailing address:
  • Phone: 512-454-5721
  • Fax: 512-454-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH0811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: