MEDICARE: SYDNEY DICKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1023909561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY DICKSON

Provider Business Mailing Address
First Line	:	68 LUCY CRK APT 3
Second Line	:
City	:	AMELIA
State	:	OH
Zip	:	45102-1538
Country	:	US
Telephone Number	:	740-616-7327
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 LOUIE B NUNN DR
Second Line	:
City	:	NEWPORT
State	:	KY
Zip	:	41099-9992
Country	:	US
Telephone Number	:	859-572-5220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2025
Last Update Date	:	07/12/2025

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Directions to “ SYDNEY DICKSON ” Practice Location

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