Provider Demographics
NPI:1053017616
Name:SHIVERS, SYDNEY PAIGE (PA-C)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:PAIGE
Last Name:SHIVERS
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 1:7940 SHOAL CREEK BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-8059
Mailing Address - Country:US
Mailing Address - Phone:512-454-8378
Mailing Address - Fax:512-454-8375
Practice Address - Street 1:7940 SHOAL CREEK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8059
Practice Address - Country:US
Practice Address - Phone:512-454-8378
Practice Address - Fax:512-454-8375
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16477363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical