Healthcare Provider Details

I. General information

NPI: 1275400053
Provider Name (Legal Business Name): SAFIYA SANNA SPIVEY CCMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/24/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 OLD PINEVILLE RD
CHARLOTTE NC
28217
US

IV. Provider business mailing address

5800 OLD PINEVILLE RD
CHARLOTTE NC
28217
US

V. Phone/Fax

Practice location:
  • Phone: 866-299-4968
  • Fax:
Mailing address:
  • Phone: 866-299-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2D75A2
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: