Healthcare Provider Details

I. General information

NPI: 1467910265
Provider Name (Legal Business Name): SYDNEY T. DE CEJKA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4804 W CLEARWATER AVE
KENNEWICK WA
99336-2119
US

IV. Provider business mailing address

4804 W CLEARWATER AVE
KENNEWICK WA
99336-2119
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2355
  • Fax: 509-222-1289
Mailing address:
  • Phone: 509-942-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60943884
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: