Provider Demographics
NPI:1104676816
Name:SHULTZ, SYDNEY M
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:M
Last Name:SHULTZ
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 1:6136 BEAUMONT SQ
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8157
Mailing Address - Country:US
Mailing Address - Phone:740-972-0870
Mailing Address - Fax:
Practice Address - Street 1:6136 BEAUMONT SQ
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8157
Practice Address - Country:US
Practice Address - Phone:740-972-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide