Healthcare Provider Details

I. General information

NPI: 1134763469
Provider Name (Legal Business Name): AMY SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 LITHIA PINECREST RD
VALRICO FL
33596-5632
US

IV. Provider business mailing address

9611 KONA VILLAGE DR APT 106
RIVERVIEW FL
33578-5210
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-1106
  • Fax:
Mailing address:
  • Phone: 813-924-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI4056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: