Healthcare Provider Details

I. General information

NPI: 1295627768
Provider Name (Legal Business Name): ANGELA SYPHASEUT AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAROLINA ST
GREENSBORO NC
27401-1303
US

IV. Provider business mailing address

340 HERNDON LN
BOONE NC
28607-6572
US

V. Phone/Fax

Practice location:
  • Phone: 336-522-5700
  • Fax:
Mailing address:
  • Phone: 336-572-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5022659
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: