Provider Demographics
NPI:1881980290
Name:RAPHAEL, SYDNEE PAULINE (RN)
Entity type:Individual
Prefix:
First Name:SYDNEE
Middle Name:PAULINE
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9123 SAN DIEGO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5713
Mailing Address - Country:US
Mailing Address - Phone:805-466-1647
Mailing Address - Fax:
Practice Address - Street 1:9123 SAN DIEGO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5713
Practice Address - Country:US
Practice Address - Phone:805-466-1647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN477250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health