MEDICARE: DR. SIDNEY NICOLE GARDNER COLE

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	103TC0700X	Clinical Psychologist	PSY34862	CA

General Provider Information

NPI Number	:	1700468311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIDNEY NICOLE GARDNER COLE

Provider Business Mailing Address
First Line	:	PO BOX 61740
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92602-6058
Country	:	US
Telephone Number	:	562-965-2806
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 MITCHELL DR STE 119
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-1622
Country	:	US
Telephone Number	:	562-965-2806
Fax Number	:

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

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	07/28/2025

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