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General NPI Number Information
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NPI Number | 1588032197
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Entity Type | Individual
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Provider Name | SAMANTHA SEDIVY
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Gender | Female
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 1704 OLD HONEYCUTT RD
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-8977
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Country | US
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Telephone | 919-906-6232
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Fax |
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Provider Business Mailing Address
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Address Line | 4804 DURGANCROFT PL
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-8690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | LAT-3860
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License Number State | NC
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