Provider Demographics
NPI:1023690880
Name:FEESER, SYDNEY MAIRE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MAIRE
Last Name:FEESER
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 1:7254 CHATEAUROUX DR APT A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5377
Mailing Address - Country:US
Mailing Address - Phone:937-825-7439
Mailing Address - Fax:
Practice Address - Street 1:7254 CHATEAUROUX DR APT A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-5377
Practice Address - Country:US
Practice Address - Phone:937-825-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171R00000X
261QA0600X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No171R00000XOther Service ProvidersInterpreter
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care