Healthcare Provider Details

I. General information

NPI: 1942922968
Provider Name (Legal Business Name): SYDNEY SLATTERY BRANNOCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY SLATTERLY RN

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BILLINGSLEY RD STE 100
CHARLOTTE NC
28211-3096
US

IV. Provider business mailing address

5960 FAIRVIEW RD STE 500
CHARLOTTE NC
28210-3113
US

V. Phone/Fax

Practice location:
  • Phone: 704-495-6334
  • Fax:
Mailing address:
  • Phone: 704-495-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5023511
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number338858
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: