Provider Demographics
NPI:1255986733
Name:CORL, SYDNEY ROSE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ROSE
Last Name:CORL
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 1:16 HOLLY BUSH LN
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2436
Mailing Address - Country:US
Mailing Address - Phone:860-823-7733
Mailing Address - Fax:
Practice Address - Street 1:221 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1303
Practice Address - Country:US
Practice Address - Phone:860-823-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program