MEDICARE: SYDNEY MEADE PA

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	9121233	FL
2	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9121233	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1689531204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY MEADE PA

Provider Business Mailing Address
First Line	:	188 GODFREY RD
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32141-7219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 BEVILLE RD STE 502
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5616
Country	:	US
Telephone Number	:	386-231-4690
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/27/2026

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Directions to “ SYDNEY MEADE PA” Practice Location

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