Healthcare Provider Details

I. General information

NPI: 1609792308
Provider Name (Legal Business Name): SYDNEY GALLAGHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

6600 CANTERBURY DR
HUDSON OH
44236-3481
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6601
  • Fax:
Mailing address:
  • Phone: 234-281-5330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010381RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: