Healthcare Provider Details

I. General information

NPI: 1053929182
Provider Name (Legal Business Name): ROBERT SWEDO HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SHERINGTON DR
BLUFFTON SC
29910-6030
US

IV. Provider business mailing address

25 SHERINGTON DR
BLUFFTON SC
29910-6030
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-2693
  • Fax: 678-802-0542
Mailing address:
  • Phone: 843-836-2693
  • Fax: 678-802-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-0688
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: