Provider Demographics
NPI:1295627768
Name:SYPHASEUT, ANGELA (AGNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SYPHASEUT
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HERNDON LN
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6572
Mailing Address - Country:US
Mailing Address - Phone:336-572-2550
Mailing Address - Fax:
Practice Address - Street 1:1201 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1303
Practice Address - Country:US
Practice Address - Phone:336-522-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022659363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology