Healthcare Provider Details

I. General information

NPI: 1023073517
Provider Name (Legal Business Name): SYLVIA S MEADS ROFM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MEDICAL DRIVE
ELIZ CITY NC
27909
US

IV. Provider business mailing address

PO BOX 1471 106 MEDICAL DRIVE
ELIZ CITY NC
27909
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-3002
  • Fax: 252-338-2902
Mailing address:
  • Phone: 252-338-3002
  • Fax: 252-338-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFOM0204
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code229N00000X
TaxonomyAnaplastologist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: