Provider Demographics
NPI:1306514161
Name:MENDEZ, SIDRA TUFON (PA-C)
Entity type:Individual
Prefix:
First Name:SIDRA
Middle Name:TUFON
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SIDRA
Other - Middle Name:A
Other - Last Name:TUFON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 S 13TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4107
Practice Address - Country:US
Practice Address - Phone:360-814-6113
Practice Address - Fax:360-814-6111
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61564913363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical