Provider Demographics
NPI:1659754554
Name:SEDWICK, CARLY NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:NICOLE
Last Name:SEDWICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 DOUG WHITE DR STE 430
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4182
Mailing Address - Country:US
Mailing Address - Phone:843-903-6459
Mailing Address - Fax:843-839-0218
Practice Address - Street 1:320 E NORTH AVE STE 401
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-4352
Practice Address - Fax:412-359-8285
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058189363A00000X
SC2820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103151404Medicaid
531142Medicare PIN