Healthcare Provider Details

I. General information

NPI: 1497660609
Provider Name (Legal Business Name): SYDNEY E BUCKNUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LAIRD ST STE 200
WILKES BARRE PA
18702-6935
US

IV. Provider business mailing address

106 WAGNER RD
EVANS CITY PA
16033-3032
US

V. Phone/Fax

Practice location:
  • Phone: 267-668-2908
  • Fax:
Mailing address:
  • Phone: 714-353-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA068027
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: