Provider Demographics
NPI:1508544677
Name:SYDORYAK, SOFIYA MARIYA (LAC)
Entity type:Individual
Prefix:
First Name:SOFIYA
Middle Name:MARIYA
Last Name:SYDORYAK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 DUBLIN MANOR RD
Mailing Address - Street 2:
Mailing Address - City:STREET
Mailing Address - State:MD
Mailing Address - Zip Code:21154-1925
Mailing Address - Country:US
Mailing Address - Phone:215-687-3095
Mailing Address - Fax:
Practice Address - Street 1:260 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4268
Practice Address - Country:US
Practice Address - Phone:215-687-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU03192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty