Provider Demographics
NPI:1093826737
Name:KOMETANI, SYDNEY MAILE (MD)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:MAILE
Last Name:KOMETANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E 32ND, #405
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-476-0896
Mailing Address - Fax:
Practice Address - Street 1:1015 E 32ND, #405
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-476-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK7783OtherMEDICAL LICENSE
TX80174836OtherTEXAS DPS REGISTRATION NUMBER
BK8269094OtherDRUG ENFORCEMENT ADMIN