Healthcare Provider Details

I. General information

NPI: 1881260347
Provider Name (Legal Business Name): SYDNEIGH NICOLE BANKS LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDENEIGH BEATTY

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

IV. Provider business mailing address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0145
  • Fax: 910-202-9966
Mailing address:
  • Phone: 910-343-0145
  • Fax: 910-202-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC016454
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP015034
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: