Provider Demographics
NPI:1902619760
Name:COLLIGAN, SYDNEY (MS, RDN)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:COLLIGAN
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:PORTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14770-0677
Mailing Address - Country:US
Mailing Address - Phone:716-574-9957
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 677
Practice Address - Street 2:
Practice Address - City:PORTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14770-0677
Practice Address - Country:US
Practice Address - Phone:716-574-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86358229133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered