Provider Demographics
NPI:1518329275
Name:DIGIACOMO, SYDNE ISABELLA
Entity Type:Individual
Prefix:MS
First Name:SYDNE
Middle Name:ISABELLA
Last Name:DIGIACOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SYDNE
Other - Middle Name:DOMINIQUE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-3974
Mailing Address - Fax:913-588-0359
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-7220
Practice Address - Country:US
Practice Address - Phone:913-588-3974
Practice Address - Fax:913-588-0593
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1518329275OtherKANSAS BOARD OF HEALING ARTS- POSTGRADUATE PERMIT