Provider Demographics
NPI:1205617271
Name:EVANS, SYDNEY
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:EVANS
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:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:SALEMBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28385-0391
Mailing Address - Country:US
Mailing Address - Phone:813-468-9975
Mailing Address - Fax:
Practice Address - Street 1:303 E ROSEBORO ST
Practice Address - Street 2:
Practice Address - City:ROSEBORO
Practice Address - State:NC
Practice Address - Zip Code:28382
Practice Address - Country:US
Practice Address - Phone:910-260-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC352006174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN