Provider Demographics
NPI:1417604976
Name:SCHULTZ, SYDNEY CHRISTINE
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CHRISTINE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 S HOWELL AVE STE 1600
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1460
Mailing Address - Country:US
Mailing Address - Phone:262-476-4900
Mailing Address - Fax:
Practice Address - Street 1:7003 S HOWELL AVE STE 1600
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1460
Practice Address - Country:US
Practice Address - Phone:262-476-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7031-23202K00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty