Healthcare Provider Details

I. General information

NPI: 1912703372
Provider Name (Legal Business Name): SYDNEY DANIELLE FALLEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44055 RIVERSIDE PKWY STE 238
LEESBURG VA
20176-5178
US

IV. Provider business mailing address

44055 RIVERSIDE PKWY STE 238
LEESBURG VA
20176-5178
US

V. Phone/Fax

Practice location:
  • Phone: 937-823-9387
  • Fax:
Mailing address:
  • Phone: 937-823-9387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: