Provider Demographics
NPI:1164198339
Name:SYKES, JAEDA L
Entity Type:Individual
Prefix:
First Name:JAEDA
Middle Name:L
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 1:156 CAPITAL AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5635
Mailing Address - Country:US
Mailing Address - Phone:862-621-3988
Mailing Address - Fax:
Practice Address - Street 1:156 CAPITAL AVE APT 102
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5635
Practice Address - Country:US
Practice Address - Phone:862-621-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No376K00000XNursing Service Related ProvidersNurse's Aide