Provider Demographics
NPI:1083153035
Name:KLEIN, SYDNEY SKYE
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:SKYE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 40TH AVE S
Mailing Address - Street 2:APT 310
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-7911
Mailing Address - Country:US
Mailing Address - Phone:218-779-8540
Mailing Address - Fax:
Practice Address - Street 1:1730 40TH AVE S
Practice Address - Street 2:APT 310
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-7911
Practice Address - Country:US
Practice Address - Phone:218-779-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program