Provider Demographics
NPI:1710636139
Name:STREET, SYDNEY MADISON (PA-C)
Entity type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:MADISON
Last Name:STREET
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:44405 WOODARD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:810-342-3801
Practice Address - Fax:810-342-3856
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2025-10-27
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Provider Licenses
StateLicense IDTaxonomies
MI5601011053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant