Active NPI
Sydney Holub
- Behavior Technician
- Fargo, ND
National Provider Identifier
1093477960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 4725 Amber Valley Pkwy S Ste B
Fargo, ND 58104-8614 - Phone
- (701) 478-0221
- NPI assigned
- Oct 8, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | |||
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
4725 Amber Valley Pkwy S Ste B
Fargo, ND 58104-8614
Mailing address
4725 Amber Valley Pkwy S Ste B
Fargo, ND 58104-8614
Phone (701) 478-0221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684368000000",
"number": "1093477960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4725 AMBER VALLEY PKWY S STE B",
"city": "FARGO",
"state": "ND",
"postal_code": "581048614",
"telephone_number": "701-478-0221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4725 AMBER VALLEY PKWY S STE B",
"city": "FARGO",
"state": "ND",
"postal_code": "581048614",
"telephone_number": "701-478-0221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLUB",
"first_name": "SYDNEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-08",
"last_updated": "2023-05-18",
"certification_date": "2023-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.