MEDICARE: SYDNEY MEADOWS NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	403006	NY

General Provider Information

NPI Number	:	1396361473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY MEADOWS NP

Provider Business Mailing Address
First Line	:	6150 DONALD AVE
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-1811
Country	:	US
Telephone Number	:	315-278-2203
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 JAMES ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13203-2504
Country	:	US
Telephone Number	:	315-701-1516
Fax Number	:

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

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	08/19/2020

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