Active NPI
Samantha Sedlak, PSY.D.
- Psychologist
- Mebane, NC
National Provider Identifier
1518424357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 5529
- Practice address
- 202 N Fifth St Ste B
Mebane, NC 27302-2500 - Phone
- (336) 329-6306
- Fax
- (336) 850-1858
- NPI assigned
- Feb 28, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 5529 | NC | |
| Psychologist | 103T00000X | 5529 | NC | Primary |
Addresses
Primary practice location
202 N Fifth St Ste B
Mebane, NC 27302-2500
Mailing address
PO Box 8
Mebane, NC 27302-0008
Phone (336) 329-6306
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Recon Neurology & Psychiatry | Single Specialty | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GBCJCD
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704326400000",
"number": "1518424357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8",
"city": "MEBANE",
"state": "NC",
"postal_code": "273020008",
"telephone_number": "336-329-6306",
"fax_number": "336-850-1858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 N FIFTH ST STE B",
"city": "MEBANE",
"state": "NC",
"postal_code": "273022500",
"telephone_number": "336-329-6306",
"fax_number": "336-850-1858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEDLAK",
"first_name": "SAMANTHA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-28",
"last_updated": "2024-01-04",
"certification_date": "2024-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Clinical Neuropsychologist",
"state": "NC",
"license": "5529",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "5529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mebane, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.