Provider Demographics
NPI:1427412915
Name:MANNING, SYDNEY (COTA)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MCCHESNEY AVE EXT
Mailing Address - Street 2:21-12
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8801
Mailing Address - Country:US
Mailing Address - Phone:518-338-8985
Mailing Address - Fax:
Practice Address - Street 1:673 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2130
Practice Address - Country:US
Practice Address - Phone:518-233-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356805174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist