Provider Demographics
NPI:1568887131
Name:RUDDY, SYDNEY NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:NICOLE
Last Name:RUDDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:800 S. WASHINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601
Mailing Address - Country:US
Mailing Address - Phone:989-754-3555
Mailing Address - Fax:989-754-3006
Practice Address - Street 1:800 S. WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-754-3555
Practice Address - Fax:989-754-3006
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006922363A00000X
MI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
M18034016Medicare PIN