Basic Information
Provider Information
NPI: 1972108124
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STANTON
FirstName: SYDNEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 70 E HORIZON RIDGE PKWY STE 100
Address2:  
City: HENDERSON
State: NV
PostalCode: 890027936
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 70 E HORIZON RIDGE PKWY STE 100
Address2:  
City: HENDERSON
State: NV
PostalCode: 890027936
CountryCode: US
TelephoneNumber: 7026443600
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/03/2020
LastUpdateDate: 12/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/03/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
372600000X NVN Nursing Service Related ProvidersAdult Companion 
372500000X NVN Nursing Service Related ProvidersChore Provider 
3747A0650X NVN Nursing Service Related ProvidersTechnicianAttendant Care Provider
376J00000X NVN Nursing Service Related ProvidersHomemaker 
3747P1801X NVY Nursing Service Related ProvidersTechnicianPersonal Care Attendant

No ID Information.


Home