MEDICARE: MS. ANGELYN MELODY FORSYTH LAC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	TL145	SC
2	171100000X	Acupuncturist	145	SC

General Provider Information

NPI Number	:	1154505006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELYN MELODY FORSYTH LAC.

Provider Business Mailing Address
First Line	:	8673 HICKORY CREEK CT
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-6871
Country	:	US
Telephone Number	:	843-318-0345
Fax Number	:	843-494-9644

Provider Business Practice Location Address
First Line	:	302A MIDLAND PKWY
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8102
Country	:	US
Telephone Number	:	843-318-0345
Fax Number	:	843-494-9644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/30/2011

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