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General NPI Number Information
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NPI Number | 1184389975
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Entity Type | Individual
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Provider Name | SYDNEY LORRAINE PEACOCK PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/05/2021
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 2685 E HENRIETTA RD
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City | HENRIETTA
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State | NY
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Zip | 14467-9370
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Country | US
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Telephone | 585-444-0058
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Fax |
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Provider Business Mailing Address
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Address Line | 100 KINGS HWY S
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City | ROCHESTER
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State | NY
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Zip | 14617-5504
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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 | 027684
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License Number State | NY
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