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NPI Code Detail

MEDICARE: SYDNIE BLACK

MEDICARE: SYDNIE BLACK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225800000XRecreation Therapist80390CA

General Provider Information

NPI Number : 1467328641
Entity Type Code : Individual
Provider Name (Legal Business Name) : SYDNIE BLACK
Provider Business Mailing Address
First Line : 510 17TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1553
Country : US
Telephone Number : 510-433-1150
Fax Number :
Provider Business Practice Location Address
First Line : 2441 CONSTITUTION DR
Second Line :
City : LIVERMORE
State : CA
Zip : 94551-7573
Country : US
Telephone Number : 925-505-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2025
Last Update Date : 10/24/2025

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Directions to “ SYDNIE BLACK ” Practice Location

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