Provider Demographics
NPI:1720872898
Name:CHURCHILL, SYDNEY JOSEPHINE (MD)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:JOSEPHINE
Last Name:CHURCHILL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 ALCATRAZ AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1194
Mailing Address - Country:US
Mailing Address - Phone:503-929-6028
Mailing Address - Fax:
Practice Address - Street 1:925 SENECA ST.. H8-GME
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-223-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program