Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Sidney Rodolfo Wilson, PA12

Individual provider Medical Physician Assistant · NPI 1861439523

Sidney Rodolfo Wilson, PA12 is a Medical Physician Assistant in Flushing, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2006
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

4115 162nd St
Flushing, NY 11358-4124
Phone: (718) 762-6640
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 006481 (NY)

Record details

NPI number1861439523
Entity typeIndividual (Type 1)
GenderMale
Credentials PA12
Sole proprietorYes
NPI enumeratedJune 1, 2006
Last updated in NPPESMay 4, 2010

Other providers in Flushing