Provider Demographics
NPI:1215643945
Name:ST CLAIR, SIDNEY TODD
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:TODD
Last Name:ST CLAIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4627
Mailing Address - Country:US
Mailing Address - Phone:276-389-6235
Mailing Address - Fax:
Practice Address - Street 1:1208 W 45TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4627
Practice Address - Country:US
Practice Address - Phone:276-389-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program