Provider Demographics
NPI:1114410602
Name:PALOCHAK, SIERRA ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:ROSE
Last Name:PALOCHAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W WELSH DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-8704
Mailing Address - Country:US
Mailing Address - Phone:484-769-1042
Mailing Address - Fax:
Practice Address - Street 1:1113 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4112
Practice Address - Country:US
Practice Address - Phone:302-734-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical