Healthcare Provider Details

I. General information

NPI: 1376118117
Provider Name (Legal Business Name): AMY SIEGEL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 FAIRVIEW RD STE 102
CHARLOTTE NC
28210-3111
US

IV. Provider business mailing address

5960 FAIRVIEW RD STE 102
CHARLOTTE NC
28210-3111
US

V. Phone/Fax

Practice location:
  • Phone: 980-701-4060
  • Fax:
Mailing address:
  • Phone: 980-701-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: