Provider Demographics
NPI:1811048341
Name:SIDES, JULIET NEELY (LMT)
Entity type:Individual
Prefix:MRS
First Name:JULIET
Middle Name:NEELY
Last Name:SIDES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13911 LAKESHORE BLVD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7102
Mailing Address - Country:US
Mailing Address - Phone:727-869-3803
Mailing Address - Fax:727-869-9126
Practice Address - Street 1:13911 LAKESHORE BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7102
Practice Address - Country:US
Practice Address - Phone:727-869-3803
Practice Address - Fax:727-869-9126
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48979174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist