MEDICARE: MALLORY SINCLAIR IPHM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach		SC

General Provider Information

NPI Number	:	1104764810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY SINCLAIR IPHM

Provider Business Mailing Address
First Line	:	409 MURRAY BLVD
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-9027
Country	:	US
Telephone Number	:	317-364-5071
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 MURRAY BLVD
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-9027
Country	:	US
Telephone Number	:	317-364-5071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ MALLORY SINCLAIR IPHM” Practice Location

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