Provider Demographics
NPI:1770291536
Name:BOTY, SIDNEY RAE (PA-C)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:RAE
Last Name:BOTY
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 1:347 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4202
Mailing Address - Country:US
Mailing Address - Phone:844-400-1975
Mailing Address - Fax:845-765-9322
Practice Address - Street 1:347 W 37TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4202
Practice Address - Country:US
Practice Address - Phone:844-400-1975
Practice Address - Fax:845-765-9322
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030488363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical