Provider Demographics
NPI:1083693212
Name:REDDICK, SYBIL ROCHELLE (MD)
Entity Type:Individual
Prefix:
First Name:SYBIL
Middle Name:ROCHELLE
Last Name:REDDICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 AIRPARK CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6188
Mailing Address - Country:US
Mailing Address - Phone:864-343-0010
Mailing Address - Fax:864-312-6927
Practice Address - Street 1:2270 ASHLEY CROSSING DR
Practice Address - Street 2:SUITE 155
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5732
Practice Address - Country:US
Practice Address - Phone:843-414-1224
Practice Address - Fax:843-414-1226
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9294208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC333142Medicaid
TX8F7937OtherBCBS
SCAA70963Medicare PIN
TX8G1486Medicare ID - Type Unspecified
TX8G1887Medicare ID - Type Unspecified
SC333142Medicaid