Healthcare Provider Details

I. General information

NPI: 1407632425
Provider Name (Legal Business Name): WALAA MOHAMED MOHAMED ELSEKAILY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST CSB 301, MSC 606
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

169 ASHLEY AVE RM 202
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3222
  • Fax:
Mailing address:
  • Phone: 843-792-3222
  • Fax: 843-792-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLL90785
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: