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General NPI Number Information
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NPI Number | 1679312714
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Entity Type | Individual
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Provider Name | MADISON SYDNEY YUDT
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 800 E CITY HALL AVE
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City | NORFOLK
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State | VA
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Zip | 23510-2723
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Country | US
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Telephone | 757-670-3945
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Fax |
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Provider Business Mailing Address
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Address Line | 815 LEMASTER AVE
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City | HAMPTON
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State | VA
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Zip | 23669-1210
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Country | US
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Telephone | 814-812-4647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | PPS-0608432
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License Number State | VA
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