Provider Demographics
NPI:1568112738
Name:WEINTRAUT, SYDNEE
Entity Type:Individual
Prefix:
First Name:SYDNEE
Middle Name:
Last Name:WEINTRAUT
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 1:1441 VALDOSTA CT
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8530
Mailing Address - Country:US
Mailing Address - Phone:317-642-9346
Mailing Address - Fax:
Practice Address - Street 1:1441 VALDOSTA CT
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8530
Practice Address - Country:US
Practice Address - Phone:317-642-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty