Provider Demographics
NPI:1609570571
Name:EDER, SYDNIE PAULINE
Entity Type:Individual
Prefix:
First Name:SYDNIE
Middle Name:PAULINE
Last Name:EDER
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 1:937 N 96TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3455
Mailing Address - Country:US
Mailing Address - Phone:206-829-5899
Mailing Address - Fax:
Practice Address - Street 1:937 N 96TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3455
Practice Address - Country:US
Practice Address - Phone:206-829-5899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61353549171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator