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General NPI Number Information
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NPI Number | 1124594916
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Entity Type | Individual
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Provider Name | LOGAN TAYLOR SICCHITANO PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 100 MEDICAL BLVD
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City | CANONSBURG
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State | PA
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Zip | 15317-9762
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Country | US
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Telephone | 724-745-3077
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Fax |
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Provider Business Mailing Address
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Address Line | 103 1ST ST
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City | BENTLEYVILLE
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State | PA
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Zip | 15314-1205
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA060050
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License Number State | PA
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