Provider Demographics
NPI:1871291104
Name:BLANCHARD, SYDNEY THERESE (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:THERESE
Last Name:BLANCHARD
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 1:1916 MOBLEY WAY APT 403
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2278
Mailing Address - Country:US
Mailing Address - Phone:774-473-0508
Mailing Address - Fax:
Practice Address - Street 1:1787 VETERANS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6946
Practice Address - Country:US
Practice Address - Phone:865-428-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical