Provider Demographics
NPI:1679250039
Name:SLAVTCHEFF, SYDNEY LYNN (RD)
Entity Type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:LYNN
Last Name:SLAVTCHEFF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:LYNN
Other - Last Name:MICUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3709 SE 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3632
Mailing Address - Country:US
Mailing Address - Phone:412-977-8806
Mailing Address - Fax:
Practice Address - Street 1:3709 SE 65TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3632
Practice Address - Country:US
Practice Address - Phone:412-977-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10221641133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered