Provider Demographics
NPI:1497365373
Name:BERLIN, SYDNEY NICOLE
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:NICOLE
Last Name:BERLIN
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 1:1220 BELLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1350
Mailing Address - Country:US
Mailing Address - Phone:317-858-8630
Mailing Address - Fax:
Practice Address - Street 1:1220 BELLEVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025-1350
Practice Address - Country:US
Practice Address - Phone:317-858-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007556A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist