Provider Demographics
NPI:1295512556
Name:RAYMOND, SIDNEY (PA-C)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:RAYMOND
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 1:206 WILLIAMSON RD SE APT 125
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1810
Mailing Address - Country:US
Mailing Address - Phone:724-672-0767
Mailing Address - Fax:
Practice Address - Street 1:206 WILLIAMSON RD SE APT 125
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-1810
Practice Address - Country:US
Practice Address - Phone:724-672-0767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant