Healthcare Provider Details

I. General information

NPI: 1578354627
Provider Name (Legal Business Name): SYDNEY ALYSE ANDERSON PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY ALYSE BLASER

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W UNIVERSITY PKWY
OREM UT
84058-6703
US

IV. Provider business mailing address

2278 E LOGAN AVE
SALT LAKE CITY UT
84108-2715
US

V. Phone/Fax

Practice location:
  • Phone: 801-863-8888
  • Fax:
Mailing address:
  • Phone: 602-499-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: