MEDICARE: SYDNEE ROSE ECK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	15-02392	KS
2	363A00000X	Physician Assistant	PA2880	NV

General Provider Information

NPI Number	:	1033731674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEE ROSE ECK PA-C

Provider Business Mailing Address
First Line	:	1525 VISTA LN STE 120
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4633
Country	:	US
Telephone Number	:	775-451-3376
Fax Number	:	775-490-0186

Provider Business Practice Location Address
First Line	:	1525 VISTA LN STE 120
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4633
Country	:	US
Telephone Number	:	775-451-3376
Fax Number	:	775-490-0186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2020
Last Update Date	:	11/21/2024

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