Provider Demographics
NPI:1427810365
Name:CORTRIGHT, SIDNEY SHEA
Entity type:Individual
Prefix:MS
First Name:SIDNEY
Middle Name:SHEA
Last Name:CORTRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N TYNDALL AVE APT 415
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4446
Mailing Address - Country:US
Mailing Address - Phone:602-315-5420
Mailing Address - Fax:
Practice Address - Street 1:401 N BONITA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2750
Practice Address - Country:US
Practice Address - Phone:520-232-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-23-302022106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician