MEDICARE: MS. SYDNEY ERIN GILLISPIE

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	390200000X	Student in an Organized Health Care Education/Training Program		NC

General Provider Information

NPI Number	:	1760345417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SYDNEY ERIN GILLISPIE

Provider Business Mailing Address
First Line	:	4302 TRISTON DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-7556
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4302 TRISTON DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-7556
Country	:	US
Telephone Number	:	252-299-4756
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/14/2025

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