Provider Demographics
NPI:1689207615
Name:VASSELL, SYDDONIE T (APRN)
Entity Type:Individual
Prefix:
First Name:SYDDONIE
Middle Name:T
Last Name:VASSELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3954 CIRCLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-1109
Mailing Address - Country:US
Mailing Address - Phone:561-283-9531
Mailing Address - Fax:
Practice Address - Street 1:3954 CIRCLE LAKE DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-1109
Practice Address - Country:US
Practice Address - Phone:561-283-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily