Provider Demographics
NPI:1275322356
Name:DESMOND, SYDNEY SHEA (PRSS)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:SHEA
Last Name:DESMOND
Suffix:
Gender:
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 MILL ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1499
Mailing Address - Country:US
Mailing Address - Phone:775-501-8655
Mailing Address - Fax:
Practice Address - Street 1:855 MILL ST STE 1A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1499
Practice Address - Country:US
Practice Address - Phone:775-501-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPRSS-INT-5353175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist