Provider Demographics
NPI:1952039786
Name:PARNELL, SYDNI M
Entity Type:Individual
Prefix:
First Name:SYDNI
Middle Name:M
Last Name:PARNELL
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 1:1280 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1861
Mailing Address - Country:US
Mailing Address - Phone:508-754-1141
Mailing Address - Fax:508-754-1115
Practice Address - Street 1:1280 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1861
Practice Address - Country:US
Practice Address - Phone:508-754-1141
Practice Address - Fax:508-754-1115
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC101556931OtherDRIVER'S LICENSE NUMBER