Healthcare Provider Details

I. General information

NPI: 1174394175
Provider Name (Legal Business Name): SYDNEY M SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/28/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HALKET ST
PITTSBURGH PA
15213-3108
US

IV. Provider business mailing address

100 VALERON CT
IRWIN PA
15642-8860
US

V. Phone/Fax

Practice location:
  • Phone: 412-641-7850
  • Fax:
Mailing address:
  • Phone: 724-858-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA065229
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: