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General NPI Number Information
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NPI Number | 1811587272
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Entity Type | Individual
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Provider Name | SYDNEY BLACK PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 2700 E PHILLIPS RD
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City | GREER
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State | SC
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Zip | 29650-4815
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Country | US
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Telephone | 864-235-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 106 DAVIDSON DR
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City | EASLEY
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State | SC
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Zip | 29642-8729
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Country | US
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Telephone | 864-640-1088
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 3860
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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