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General NPI Number Information
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NPI Number | 1912703372
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Entity Type | Individual
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Provider Name | SYDNEY DANIELLE FALLEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 22 S GREENE ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1590
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Country | US
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Telephone | 410-328-8667
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Fax |
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Provider Business Mailing Address
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Address Line | 490 NE 5TH AVE APT 4412
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2495
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Country | US
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Telephone | 937-823-9387
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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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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