Provider Demographics
NPI:1124825609
Name:BURGESS, SIDNEY (ECMZA)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:BURGESS
Suffix:
Gender:
Credentials:ECMZA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COCHRANE AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5621
Mailing Address - Country:US
Mailing Address - Phone:707-672-6153
Mailing Address - Fax:
Practice Address - Street 1:527 S STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4910
Practice Address - Country:US
Practice Address - Phone:707-672-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No374U00000XNursing Service Related ProvidersHome Health Aide