Provider Demographics
NPI:1689296196
Name:MADRIGAL, SYDNEY ELLEN (OD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ELLEN
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 NW 15TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4943
Mailing Address - Country:US
Mailing Address - Phone:954-662-3223
Mailing Address - Fax:
Practice Address - Street 1:1732 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3602
Practice Address - Country:US
Practice Address - Phone:954-432-7711
Practice Address - Fax:954-432-8017
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5834152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program