Individual provider · Type 1 NPI

Sidney Wilson Lavender Ii, PAC

Surgical Physician Assistant · Winston Salem, NC

NPI number 1609859313 Active

Practice location

Medical Center Blvd
Winston Salem, NC 27157-0001

Call (336) 716-2255 Map

Fax (336) 716-3348

Mailing address

PO Box 344
Winston Salem, NC 27102-0344

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X000100189 (NC)

Surgical Physician Assistant: Definition to come...

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About NPI 1609859313

Sidney Wilson Lavender Ii, PAC's National Provider Identifier is 1609859313, issued on Nov 28, 2005. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Winston Salem, NC. The record was last updated on Aug 20, 2010.