Healthcare Provider Details

I. General information

NPI: 1104932979
Provider Name (Legal Business Name): FLOYD SALLEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

8662 GLASCOW ISLAND LOOP
EDISTO SC
29438-6315
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-7316
  • Fax:
Mailing address:
  • Phone: 843-577-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number35074689
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14703
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: