MEDICARE: SEGA SIKOD PA-C

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	363AM0700X	Medical Physician Assistant	0010022440	NC

General Provider Information

NPI Number	:	1770806960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEGA SIKOD PA-C

Provider Business Mailing Address
First Line	:	919 JR HIGH SCHOOL RD
Second Line	:
City	:	SCOTLAND NECK
State	:	NC
Zip	:	27874-1219
Country	:	US
Telephone Number	:	252-826-3143
Fax Number	:	704-527-5533

Provider Business Practice Location Address
First Line	:	9425 NC HIGHWAY 305
Second Line	:
City	:	JACKSON
State	:	NC
Zip	:	27845-9679
Country	:	US
Telephone Number	:	252-529-7146
Fax Number	:

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

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	01/08/2024

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