Provider Demographics
NPI:1780171447
Name:OUTING, SYDELLE
Entity type:Individual
Prefix:
First Name:SYDELLE
Middle Name:
Last Name:OUTING
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 1:35 MOUNT MORRIS PARK W APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5642
Mailing Address - Country:US
Mailing Address - Phone:917-684-7459
Mailing Address - Fax:
Practice Address - Street 1:35 MOUNT MORRIS PARK W APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5642
Practice Address - Country:US
Practice Address - Phone:917-684-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator