Individual
SIERRA N WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1575 SEAMANS NECK RD, SEAFORD, NY 11783-2055
(631) 560-6489
Mailing address
404 1ST AVE, BAYPORT, NY 11705-1305
(631) 560-6489
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003451
NY
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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