Provider Demographics
NPI:1376678516
Name:SPIESEL, SYDNEY ZANE (PHD,MD)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:ZANE
Last Name:SPIESEL
Suffix:
Gender:M
Credentials:PHD,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LUNAR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2352
Mailing Address - Country:US
Mailing Address - Phone:203-397-5211
Mailing Address - Fax:203-397-1875
Practice Address - Street 1:8 LUNAR DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2352
Practice Address - Country:US
Practice Address - Phone:203-397-5211
Practice Address - Fax:203-397-1875
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0181542080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT698OtherSTATE NARCOTIC IDENTIFIER
CTAS6713689OtherDEA NUMBER
CT698OtherSTATE NARCOTIC IDENTIFIER