Provider Demographics
NPI:1013508506
Name:BLACK, SYDNEY (AUD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 BUDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3214
Mailing Address - Country:US
Mailing Address - Phone:814-262-3950
Mailing Address - Fax:
Practice Address - Street 1:348 BUDFIELD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3214
Practice Address - Country:US
Practice Address - Phone:814-262-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006719231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist