Healthcare Provider Details

I. General information

NPI: 1962968008
Provider Name (Legal Business Name): SANDRA D SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7197 JOHNSONTOWN RD
ELIZABETHTOWN NC
28337-6326
US

IV. Provider business mailing address

7197 JOHNSONTOWN RD
ELIZABETHTOWN NC
28337-6326
US

V. Phone/Fax

Practice location:
  • Phone: 910-583-1659
  • Fax:
Mailing address:
  • Phone: 910-583-1659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: