Healthcare Provider Details

I. General information

NPI: 1215632617
Provider Name (Legal Business Name): SYDNEY GUALTIERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N WASHINGTON ST
SUMTER SC
29150-4949
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-9680
  • Fax: 803-434-3955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number89721
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: