Provider Demographics
NPI:1629669015
Name:VAN DELLEN, SYDNEY (PA-C)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:VAN DELLEN
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 1:16830 DUMFRIES RD
Mailing Address - Street 2:STE 160
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025
Mailing Address - Country:US
Mailing Address - Phone:703-523-1750
Mailing Address - Fax:844-518-0708
Practice Address - Street 1:16830 DUMFRIES RD
Practice Address - Street 2:STE 160
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025
Practice Address - Country:US
Practice Address - Phone:703-523-1750
Practice Address - Fax:844-518-0708
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA59181363A00000X
VA0110009288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant