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General NPI Number Information
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NPI Number | 1770291536
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Entity Type | Individual
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Provider Name | SIDNEY RAE BOTY PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/10/2022
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 347 W 37TH ST
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City | NEW YORK
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State | NY
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Zip | 10018-4202
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Country | US
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Telephone | 844-400-1975
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Fax | 845-765-9322
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Provider Business Mailing Address
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Address Line | 347 W 37TH ST
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City | NEW YORK
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State | NY
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Zip | 10018-4202
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Country | US
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Telephone | 844-400-1975
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Fax | 845-765-9322
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 030488
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License Number State | NY
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