MEDICARE: DR. JENNIFER LEE SAPIA PHD

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	103T00000X	Psychologist	2727	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	046RG	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	045MG	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1396739215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LEE SAPIA PHD

Provider Business Mailing Address
First Line	:	4320 SOUTHPORT SUPPLY RD SE
Second Line	:	SUITE 400
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-8158
Country	:	US
Telephone Number	:	910-457-0800
Fax Number	:	910-457-1072

Provider Business Practice Location Address
First Line	:	4320 SOUTHPORT SUPPLY RD SE
Second Line	:	SUITE 400
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-8158
Country	:	US
Telephone Number	:	910-457-0800
Fax Number	:	910-457-1072

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	03/21/2012

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