Provider Demographics
NPI:1588413496
Name:REEDER, SYDNEY MIMS (CRNA)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MIMS
Last Name:REEDER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:SANDERS
Other - Last Name:MIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 REDBUD CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5935
Mailing Address - Country:US
Mailing Address - Phone:334-477-4043
Mailing Address - Fax:
Practice Address - Street 1:4370 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4000
Practice Address - Country:US
Practice Address - Phone:334-793-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-176556367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered