Basic Information
Provider Information
NPI: 1154089738
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PRESLIN
FirstName: SYDNEY
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 718 N ZANE HWY
Address2:  
City: MARTINS FERRY
State: OH
PostalCode: 439351732
CountryCode: US
TelephoneNumber: 3042181807
FaxNumber:  
Practice Location
Address1: 1 HALLORAN LN
Address2:  
City: SAINT CLAIRSVILLE
State: OH
PostalCode: 43950
CountryCode: US
TelephoneNumber: 7402965743
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/01/2021
LastUpdateDate: 12/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X OHY    

No ID Information.


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