Healthcare Provider Details

I. General information

NPI: 1235157330
Provider Name (Legal Business Name): DEBORAH J BERRY-TAYLOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 ISLAND PARK DR STE 200
DANIEL ISLAND SC
29492
US

IV. Provider business mailing address

201 SIGMA DR STE 100
SUMMERVILLE SC
29486-7715
US

V. Phone/Fax

Practice location:
  • Phone: 843-856-6402
  • Fax: 843-216-5068
Mailing address:
  • Phone: 843-695-6071
  • Fax: 843-569-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN1502
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: