Individual
MANDY COLLINS SILLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
(814) 260-5471
(814) 260-5473
Mailing address
506 E OAK ST, COUDERSPORT, PA 16915-1541
(814) 274-0658
(814) 274-8153
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA052865
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109013JT3
MEDICARE
PA
Enumeration date
01/30/2007
Last updated
12/10/2008
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