Provider Demographics
NPI:1013649888
Name:COSTA, SYDNEY PAIGE
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:PAIGE
Last Name:COSTA
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 1:343 KENYON ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-7432
Mailing Address - Country:US
Mailing Address - Phone:508-728-8401
Mailing Address - Fax:
Practice Address - Street 1:343 KENYON ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-7432
Practice Address - Country:US
Practice Address - Phone:508-728-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant