Provider Demographics
NPI:1164113353
Name:LEE, SYDNEY SMITH (AUD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:SMITH
Last Name:LEE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720A MEDICAL PARK DR STE 140
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2122
Mailing Address - Country:US
Mailing Address - Phone:228-207-7102
Mailing Address - Fax:
Practice Address - Street 1:1720A MEDICAL PARK DR STE 140
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2122
Practice Address - Country:US
Practice Address - Phone:228-207-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA-4698231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist