Provider Demographics
NPI:1982263703
Name:WINNER, SYDNEY BROOKE
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:BROOKE
Last Name:WINNER
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 1:5350 SHEA ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6918
Mailing Address - Country:US
Mailing Address - Phone:954-790-4811
Mailing Address - Fax:
Practice Address - Street 1:5350 SHEA ST UNIT 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6918
Practice Address - Country:US
Practice Address - Phone:954-790-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA18262OtherFLORIDA SPEECH LANGUAGE PATHOLOGIST LICENSE
FLSZ9029OtherFL PROVISIONAL SLP LICENSE
CA33882OtherCALIFORNIA SPEECH PATHOLOGIST