Provider Demographics
NPI:1891360012
Name:SYKES, MISHA MONETTE
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:MONETTE
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 1:1515 OLD GRANTHAM RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-8942
Mailing Address - Country:US
Mailing Address - Phone:919-394-3202
Mailing Address - Fax:
Practice Address - Street 1:1515 OLD GRANTHAM RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8942
Practice Address - Country:US
Practice Address - Phone:919-394-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities