Provider Demographics
NPI:1306373154
Name:SYKES, LYSANDRA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LYSANDRA
Middle Name:
Last Name:SYKES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 WALLS RD
Mailing Address - Street 2:
Mailing Address - City:VILAS
Mailing Address - State:NC
Mailing Address - Zip Code:28692-8937
Mailing Address - Country:US
Mailing Address - Phone:336-462-8619
Mailing Address - Fax:
Practice Address - Street 1:285 WALLS ROAD
Practice Address - Street 2:
Practice Address - City:VILAS
Practice Address - State:NC
Practice Address - Zip Code:28692
Practice Address - Country:US
Practice Address - Phone:336-462-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NC12397235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist