Provider Demographics
NPI:1184742900
Name:SYDNOR, MYRA
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:SYDNOR
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 1:2 HELMS PICK CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2407
Mailing Address - Country:US
Mailing Address - Phone:410-747-5556
Mailing Address - Fax:
Practice Address - Street 1:190 ADMIRAL COCHRANE DR
Practice Address - Street 2:SUITE 180
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7365
Practice Address - Country:US
Practice Address - Phone:410-571-6411
Practice Address - Fax:410-571-6415
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist