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General NPI Number Information
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NPI Number | 1801665542
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Entity Type | Individual
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Provider Name | SYDNEY MONDSHINE PA
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Gender | Female
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 17 W MADISON AVE
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City | ATHENS
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State | TN
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Zip | 37303-4251
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Country | US
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Telephone | 423-717-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 8658 TRADEWIND CIR APT 404
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City | OOLTEWAH
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State | TN
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Zip | 37363-2943
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Country | US
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Telephone | 832-314-8163
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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 | 5851
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License Number State | TN
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