Healthcare Provider Details

I. General information

NPI: 1346137320
Provider Name (Legal Business Name): BRANDI LEIGH BRINKLEY CST, CSFA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

188 GRANT DR
DORCHESTER SC
29437-4316
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-7000
  • Fax:
Mailing address:
  • Phone: 843-670-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number201389
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: