Provider Demographics
NPI:1962968008
Name:SYKES, SANDRA D
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:SYKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7197 JOHNSONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-6326
Mailing Address - Country:US
Mailing Address - Phone:910-583-1659
Mailing Address - Fax:
Practice Address - Street 1:7197 JOHNSONTOWN RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-6326
Practice Address - Country:US
Practice Address - Phone:910-583-1659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier