Active NPI
Samantha Sedivy
- Athletic Trainer
- Fuquay Varina, NC
National Provider Identifier
1588032197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- LAT-3860
- Practice address
- 1704 Old Honeycutt Rd
Fuquay Varina, NC 27526-8977 - Phone
- (919) 906-6232
- NPI assigned
- Sep 14, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | LAT-3860 | NC | Primary |
Addresses
Primary practice location
1704 Old Honeycutt Rd
Fuquay Varina, NC 27526-8977
Mailing address
4804 Durgancroft PL
Fuquay Varina, NC 27526-8690
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAT-3860 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682467200000",
"number": "1588032197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4804 DURGANCROFT PL",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275268690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1704 OLD HONEYCUTT RD",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275268977",
"telephone_number": "919-906-6232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEDIVY",
"first_name": "SAMANTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-14",
"last_updated": "2023-04-26",
"certification_date": "2021-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "LAT-3860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fuquay Varina, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.