Provider Demographics
NPI:1053091892
Name:MELANSON, SYDNEY MATTHEWS (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MATTHEWS
Last Name:MELANSON
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S 150 E UNIT 8
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-1262
Mailing Address - Country:US
Mailing Address - Phone:623-688-7011
Mailing Address - Fax:
Practice Address - Street 1:835 N 3050 E
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-9041
Practice Address - Country:US
Practice Address - Phone:435-256-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13421689-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer