Provider Demographics
NPI:1316767593
Name:HAYNES, SYDNEY NICHOLE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:NICHOLE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 DEERCROSS LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6604
Mailing Address - Country:US
Mailing Address - Phone:704-698-5214
Mailing Address - Fax:
Practice Address - Street 1:709 DEERCROSS LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-6604
Practice Address - Country:US
Practice Address - Phone:704-698-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL008248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered