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NPI Code Detail

MEDICARE: SIDNEY ELIZABETH NICOLE MEDAUGH LCDCIII

MEDICARE: SIDNEY ELIZABETH NICOLE MEDAUGH LCDCIII
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.163026OH

General Provider Information

NPI Number : 1033820931
Entity Type Code : Individual
Provider Name (Legal Business Name) : SIDNEY ELIZABETH NICOLE MEDAUGH LCDCIII
Provider Business Mailing Address
First Line : 4600 MONTGOMERY RD STE 400
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2600
Country : US
Telephone Number : 833-510-4357
Fax Number : 866-460-2997
Provider Business Practice Location Address
First Line : 8120 GARNET DR
Second Line :
City : DAYTON
State : OH
Zip : 45458-2141
Country : US
Telephone Number : 866-934-7450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2022
Last Update Date : 06/25/2026

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Directions to “ SIDNEY ELIZABETH NICOLE MEDAUGH LCDCIII” Practice Location

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