Provider Demographics
NPI:1811498058
Name:CAVERO-EGUSQUIZA, SYDNEY ELYSE (MS, RD/LD)
Entity type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:ELYSE
Last Name:CAVERO-EGUSQUIZA
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:MISS
Other - First Name:SYDNEY
Other - Middle Name:ELYSE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD/LD
Mailing Address - Street 1:4815 S HARVARD AVE STE 253
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3066
Mailing Address - Country:US
Mailing Address - Phone:918-280-9418
Mailing Address - Fax:539-664-9824
Practice Address - Street 1:7633 E 63RD PL STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1202
Practice Address - Country:US
Practice Address - Phone:918-280-9418
Practice Address - Fax:539-664-9824
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1938133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered