Healthcare Provider Details

I. General information

NPI: 1013781517
Provider Name (Legal Business Name): SYDNEY WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

1900 FERRY ST
EASTON PA
18042-3967
US

V. Phone/Fax

Practice location:
  • Phone: 866-785-8537
  • Fax:
Mailing address:
  • Phone: 302-745-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberRT007965
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: