Provider Demographics
NPI:1134599327
Name:BIANCO, SYDNEY LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LEIGH
Last Name:BIANCO
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 1:139 RIVER ST REAR
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434-1236
Mailing Address - Country:US
Mailing Address - Phone:570-204-7778
Mailing Address - Fax:
Practice Address - Street 1:6400 FANNIN ST STE 2500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1537
Practice Address - Country:US
Practice Address - Phone:713-486-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059086363A00000X
NY019151363AS0400X
TXPA18380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical