Provider Demographics
NPI:1235731241
Name:VAUGHN, SYDNEY TAYLOR
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:TAYLOR
Last Name:VAUGHN
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 1:6 MIDTOWN TERRACE
Mailing Address - Street 2:APT 6G
Mailing Address - City:MOUNT HOPE
Mailing Address - State:WV
Mailing Address - Zip Code:25880
Mailing Address - Country:US
Mailing Address - Phone:304-237-8345
Mailing Address - Fax:
Practice Address - Street 1:6 MIDTOWN TERRACE
Practice Address - Street 2:APT 6G
Practice Address - City:MOUNT HOPE
Practice Address - State:WV
Practice Address - Zip Code:25880-2588
Practice Address - Country:US
Practice Address - Phone:304-237-8345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant