MEDICARE: SYDNEY WELLS

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	225X00000X	Occupational Therapist	17797	NC
2	225X00000X	Occupational Therapist
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1215687769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY WELLS

Provider Business Mailing Address
First Line	:	104 LANIA SHORE WAY APT 202
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-4229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 LANIA SHORE WAY APT 202
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-4229
Country	:	US
Telephone Number	:	336-233-7301
Fax Number	:

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

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	06/10/2026

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