Provider Demographics
NPI:1568531481
Name:SYKES, PORTIA DEANNE (DN)
Entity Type:Individual
Prefix:DR
First Name:PORTIA
Middle Name:DEANNE
Last Name:SYKES
Suffix:
Gender:F
Credentials:DN
Other - Prefix:DR
Other - First Name:PORTIA
Other - Middle Name:DEANNE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DN
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499
Mailing Address - Country:US
Mailing Address - Phone:505-327-0086
Mailing Address - Fax:505-327-3212
Practice Address - Street 1:8100 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402
Practice Address - Country:US
Practice Address - Phone:505-327-0086
Practice Address - Fax:505-327-3212
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0011204C00000X
IL204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine