Provider Demographics
NPI:1558643486
Name:SIY-KEANE, LAUREN T (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:T
Last Name:SIY-KEANE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:T
Other - Last Name:SIY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:123 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1407
Mailing Address - Country:US
Mailing Address - Phone:518-701-2000
Mailing Address - Fax:518-701-2020
Practice Address - Street 1:400 PATROON CREEK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5065
Practice Address - Country:US
Practice Address - Phone:518-701-2000
Practice Address - Fax:518-701-2020
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03406668Medicaid
NY56596AOtherOTOLARYNGOLOGY