Provider Demographics
NPI:1417513383
Name:RAY, SYDNII MARI (PAC)
Entity Type:Individual
Prefix:
First Name:SYDNII
Middle Name:MARI
Last Name:RAY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3130 SQUALICUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1940
Mailing Address - Country:US
Mailing Address - Phone:360-671-4509
Mailing Address - Fax:360-756-5184
Practice Address - Street 1:3130 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1940
Practice Address - Country:US
Practice Address - Phone:360-671-4509
Practice Address - Fax:360-756-5184
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA2187363AS0400X
WAPA61377687363AM0700X
NV363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA61377687OtherSTATE LICENSE NUMBER
CA1169274OtherNCCPA ID