Provider Demographics
NPI:1932838539
Name:SIDA, WOYESSA DURESSA
Entity type:Individual
Prefix:DR
First Name:WOYESSA
Middle Name:DURESSA
Last Name:SIDA
Suffix:
Gender:M
Credentials:
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 404
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0404
Mailing Address - Country:US
Mailing Address - Phone:207-973-9632
Mailing Address - Fax:207-973-4832
Practice Address - Street 1:PO BOX 404
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04402-0404
Practice Address - Country:US
Practice Address - Phone:207-973-9632
Practice Address - Fax:207-973-4832
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
MEMD29205208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program