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NPI Code Detail

MEDICARE: SYDNEY BERRY

MEDICARE: SYDNEY BERRY
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
1106S00000XBehavior Technician22-198734OK

General Provider Information

NPI Number : 1164183844
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYDNEY BERRY
Provider Business Mailing Address
First Line : 1717 S AIR DEPOT BLVD
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-5103
Country : US
Telephone Number : 405-622-4239
Fax Number :
Provider Business Practice Location Address
First Line : 1717 S AIR DEPOT BLVD
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-5103
Country : US
Telephone Number : 405-622-4239
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2022
Last Update Date : 01/05/2022

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Directions to “ SYDNEY BERRY ” Practice Location

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