MEDICARE: SYDNEY NOEL DEAN

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1992319693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY NOEL DEAN

Provider Business Mailing Address
First Line	:	79 PERFORMANCE DR
Second Line	:
City	:	GREEN SPRING
State	:	WV
Zip	:	26722-4607
Country	:	US
Telephone Number	:	240-920-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	79 PERFORMANCE DR
Second Line	:
City	:	GREEN SPRING
State	:	WV
Zip	:	26722-4607
Country	:	US
Telephone Number	:	240-920-2500
Fax Number	:

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

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	07/08/2021

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