Provider Demographics
NPI:1073998464
Name:SYD ASSOCIATES, PA
Entity Type:Organization
Organization Name:SYD ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-359-8962
Mailing Address - Street 1:PO BOX 8359
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34985-8359
Mailing Address - Country:US
Mailing Address - Phone:772-380-4490
Mailing Address - Fax:772-380-4493
Practice Address - Street 1:10696 SW VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2358
Practice Address - Country:US
Practice Address - Phone:772-380-4490
Practice Address - Fax:772-380-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11997261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental