Provider Demographics
NPI:1225803281
Name:SKUTT, SYDNEY PARKER (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:PARKER
Last Name:SKUTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:PARKER GREAVES
Other - Last Name:STANION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:448 N WERTH BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-7500
Mailing Address - Country:US
Mailing Address - Phone:503-554-2522
Mailing Address - Fax:
Practice Address - Street 1:6640 SW REDWOOD LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7187
Practice Address - Country:US
Practice Address - Phone:503-221-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA223910363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty