Provider Demographics
NPI:1104215755
Name:MALONE, SYDNEY MIKAYLA
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MIKAYLA
Last Name:MALONE
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 1:4515 S DURANGO DR APT 1033
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6076
Mailing Address - Country:US
Mailing Address - Phone:530-305-7246
Mailing Address - Fax:
Practice Address - Street 1:757 VISCANIO PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-7570
Practice Address - Country:US
Practice Address - Phone:702-675-4953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor