Provider Demographics
NPI:1154583888
Name:PENNIE, SYLVIA AMY (LSA)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:AMY
Last Name:PENNIE
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:MS
Other - First Name:SILVIA
Other - Middle Name:AMY
Other - Last Name:KORENEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSA
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:STE 618
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3560
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:1 SUGAR CREEK BLVD
Practice Address - Street 2:STE 618
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00379363AS0400X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8RF039OtherBLUE STAR SURGICAL ASSISTANTS
TX8RF181OtherUS MSO
TX8RF042OtherUNIVERSAL SURGICAL PARTNERS
TX8RE918OtherUNIVERSAL SURGICAL ASSISTANTS
TX8RF043OtherXCITE SURGICAL