Provider Demographics
NPI:1841063054
Name:PEDE, SYDNEY (HIS)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:PEDE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 NORTH WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203
Mailing Address - Country:US
Mailing Address - Phone:701-787-5862
Mailing Address - Fax:701-738-2371
Practice Address - Street 1:121 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203
Practice Address - Country:US
Practice Address - Phone:701-787-5862
Practice Address - Fax:701-738-2371
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDH-0455237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist