Healthcare Provider Details

I. General information

NPI: 1912206830
Provider Name (Legal Business Name): SYDNEY C ONDRASIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY C. MANBECK PA-C

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

537 STANTON CHRISTIANA RD STE 102
NEWARK DE
19713-2145
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA7820
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA002616
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01315
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: