Provider Demographics
NPI:1184228850
Name:MATTERN, SYDNEY (RD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:MATTERN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7166 W 1000 N
Mailing Address - Street 2:
Mailing Address - City:ROANN
Mailing Address - State:IN
Mailing Address - Zip Code:46974-9767
Mailing Address - Country:US
Mailing Address - Phone:260-330-2412
Mailing Address - Fax:
Practice Address - Street 1:7166 W 1000 N
Practice Address - Street 2:
Practice Address - City:ROANN
Practice Address - State:IN
Practice Address - Zip Code:46974-9767
Practice Address - Country:US
Practice Address - Phone:260-330-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered