Provider Demographics
NPI:1164923959
Name:SIDLE, LYNDSEY JEAN (RN)
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:JEAN
Last Name:SIDLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LYNDSEY
Other - Middle Name:JEAN
Other - Last Name:MEDEIROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 983
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-0983
Mailing Address - Country:US
Mailing Address - Phone:607-592-8514
Mailing Address - Fax:
Practice Address - Street 1:9 LIBRARY STREET
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053
Practice Address - Country:US
Practice Address - Phone:607-592-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY650172-1163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology