Healthcare Provider Details

I. General information

NPI: 1609905835
Provider Name (Legal Business Name): MELANIE SUE ANDERSON HEALTH SERVICES TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 REGISTER ST
CHARLESTON SC
29405-2421
US

IV. Provider business mailing address

7910 CROSSROADS DR APT# 16G
NORTH CHARLESTON SC
29406-9437
US

V. Phone/Fax

Practice location:
  • Phone: 843-308-9662
  • Fax: 843-308-0293
Mailing address:
  • Phone: 517-614-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: