Provider Demographics
NPI:1912780834
Name:GRAYBILL, SYDNEY (PA-C)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:BURDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14404 NW 148TH PL
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-8665
Mailing Address - Country:US
Mailing Address - Phone:352-219-3325
Mailing Address - Fax:
Practice Address - Street 1:103 US HWY 27 SW
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:FL
Practice Address - Zip Code:32008
Practice Address - Country:US
Practice Address - Phone:386-395-3090
Practice Address - Fax:386-935-3198
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117687363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical