Provider Demographics
NPI:1205694700
Name:KONECZNY, SYDNEE RAE (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEE
Middle Name:RAE
Last Name:KONECZNY
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 1:3329 CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2101
Mailing Address - Country:US
Mailing Address - Phone:586-212-3368
Mailing Address - Fax:
Practice Address - Street 1:1550 S POTOMAC ST STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5433
Practice Address - Country:US
Practice Address - Phone:720-324-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant