Healthcare Provider Details

I. General information

NPI: 1215687769
Provider Name (Legal Business Name): SYDNEY WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 LANIA SHORE WAY APT 202
HAMPSTEAD NC
28443-4229
US

IV. Provider business mailing address

104 LANIA SHORE WAY APT 202
HAMPSTEAD NC
28443-4229
US

V. Phone/Fax

Practice location:
  • Phone: 336-233-7301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17797
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 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: