Healthcare Provider Details

I. General information

NPI: 1497819221
Provider Name (Legal Business Name): LEIGH WATROBSKI DALEY P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH KRISITN WATROBSKI PA

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR STE 200E
CHARLESTON SC
29414-5742
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-958-2500
  • Fax:
Mailing address:
  • Phone: 888-472-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1540
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: