Healthcare Provider Details

I. General information

NPI: 1093264152
Provider Name (Legal Business Name): SYDNEY ANNE COLDREN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 FOREST RD
LANSING MI
48910-3720
US

IV. Provider business mailing address

4100 BEECHER RD STE A
FLINT MI
48532-3661
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-7800
  • Fax: 517-975-7810
Mailing address:
  • Phone: 810-342-3813
  • Fax: 810-342-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008322
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020189
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09483
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: