Provider Demographics
NPI:1639746423
Name:PACELLI, SYDNEY BLAIR
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:BLAIR
Last Name:PACELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 GROVE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1730
Mailing Address - Country:US
Mailing Address - Phone:973-559-3700
Mailing Address - Fax:833-484-1686
Practice Address - Street 1:200 HIGHLAND AVE STE 100B
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1521
Practice Address - Country:US
Practice Address - Phone:973-969-3800
Practice Address - Fax:833-488-1213
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant