Provider Demographics
NPI:1700224813
Name:KELLY, SYDNEY NICOLE (RDH)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:NICOLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 SATURN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2270
Mailing Address - Country:US
Mailing Address - Phone:504-253-4671
Mailing Address - Fax:
Practice Address - Street 1:1790 SATURN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2270
Practice Address - Country:US
Practice Address - Phone:504-253-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4299124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist