Healthcare Provider Details

I. General information

NPI: 1972291490
Provider Name (Legal Business Name): SYDNIE PYE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 FOREST DR STE 200
COLUMBIA SC
29204-2371
US

IV. Provider business mailing address

2611 FOREST DR STE 200
COLUMBIA SC
29204-2371
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-3263
  • Fax: 803-779-3207
Mailing address:
  • Phone: 803-779-3263
  • Fax: 803-779-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMPA.4704
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMPA.4704
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4704PA
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: