Provider Demographics
NPI:1033093083
Name:VIRDEN, SYDNEY SHEREE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:SHEREE
Last Name:VIRDEN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10226 STATE HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-5127
Mailing Address - Country:US
Mailing Address - Phone:918-613-4723
Mailing Address - Fax:
Practice Address - Street 1:10226 STATE HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-5127
Practice Address - Country:US
Practice Address - Phone:918-613-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator