Basic Information
| Provider Information | |||||||||
| NPI: | 1255643573 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIRIANNO | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602120 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804422000 | ||||||||
| FaxNumber: | 7043555800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 MOREHEAD MEDICAL DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9804422000 | ||||||||
| FaxNumber: | 7043555800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2010 | ||||||||
| LastUpdateDate: | 12/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0010-04596 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 005844 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 0010-04596 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1255643573 | 05 | NC | MEDICAID | 1833PA | 05 | SC | MEDICAID |