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General NPI Number Information
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NPI Number | 1548576754
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Entity Type | Individual
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Provider Name | ANDREY IVANOVICH SIDORENKO PA-C, DMSC
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Gender | Male
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2615 E CLINTON AVE
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City | FRESNO
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State | CA
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Zip | 93703-2223
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Country | US
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Telephone | 559-225-6100
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Fax |
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Provider Business Mailing Address
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Address Line | CMR 467 BOX 5991
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City | APO
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State | AE
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Zip | 09096-1060
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Country | US
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Telephone | 559-709-1344
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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 | 21131
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License Number State | CA
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