Provider Demographics
NPI:1083317325
Name:COLLINS, SEDRIC D
Entity Type:Individual
Prefix:MR
First Name:SEDRIC
Middle Name:D
Last Name:COLLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W 33RD ST UNIT 8021
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-9519
Mailing Address - Country:US
Mailing Address - Phone:318-499-9984
Mailing Address - Fax:
Practice Address - Street 1:8404 N 141ST EAST AVE APT 202
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2752
Practice Address - Country:US
Practice Address - Phone:318-499-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator