MEDICARE: SYDNEY MICHELLE WALSH

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	1223G0001X	General Practice Dentistry	D15458	MN

General Provider Information

NPI Number	:	1295667087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY MICHELLE WALSH

Provider Business Mailing Address
First Line	:	18820 70TH WAY N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3585
Country	:	US
Telephone Number	:	612-254-2730
Fax Number	:

Provider Business Practice Location Address
First Line	:	18820 70TH WAY N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3585
Country	:	US
Telephone Number	:	612-254-2730
Fax Number	:

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ SYDNEY MICHELLE WALSH ” Practice Location

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