Provider Demographics
NPI:1124173489
Name:MCGARY, SIDRA ANTONIA (BS)
Entity type:Individual
Prefix:MRS
First Name:SIDRA
Middle Name:ANTONIA
Last Name:MCGARY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:SIDRA
Other - Middle Name:ANTONIA
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9550 US HIGHWAY 19, STE 202
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4648
Mailing Address - Country:US
Mailing Address - Phone:352-251-8248
Mailing Address - Fax:
Practice Address - Street 1:9550 US HIGHWAY 19 STE 202
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4648
Practice Address - Country:US
Practice Address - Phone:727-494-7609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL900341538104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker