Provider Demographics
NPI:1851040810
Name:BUCKLAND, SYDNEY RAE
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:RAE
Last Name:BUCKLAND
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 1:60 REVERE RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-5917
Mailing Address - Country:US
Mailing Address - Phone:304-380-1460
Mailing Address - Fax:
Practice Address - Street 1:60 REVERE RD
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-5917
Practice Address - Country:US
Practice Address - Phone:304-380-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV90860163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management