Provider Demographics
NPI:1649865155
Name:SORNSIN, SYDNEY PAIGE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:PAIGE
Last Name:SORNSIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 W DESERT HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-4405
Mailing Address - Country:US
Mailing Address - Phone:602-329-0672
Mailing Address - Fax:
Practice Address - Street 1:7410 N ZANJERO BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-1114
Practice Address - Country:US
Practice Address - Phone:602-375-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty