Provider Demographics
NPI:1427405646
Name:BLASZCZYK, SYLVIA (PA-C)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:BLASZCZYK
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 1:7902 BARCELONA DR APT 202
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8174
Mailing Address - Country:US
Mailing Address - Phone:214-554-4107
Mailing Address - Fax:
Practice Address - Street 1:3430 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3446
Practice Address - Country:US
Practice Address - Phone:214-948-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant