Provider Demographics
NPI:1205507936
Name:MCGIFFIN, SYDNEY WILLS (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:WILLS
Last Name:MCGIFFIN
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 1:7766 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7237
Mailing Address - Country:US
Mailing Address - Phone:440-655-8389
Mailing Address - Fax:
Practice Address - Street 1:5105 SOM CENTER RD STE 107
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4203
Practice Address - Country:US
Practice Address - Phone:440-655-8389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007241RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.007241RXOtherSTATE MEDICAL BOARD OF OHIO