Healthcare Provider Details

I. General information

NPI: 1154295731
Provider Name (Legal Business Name): BRANDY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 3RD LOOP RD
FLORENCE SC
29505-3795
US

IV. Provider business mailing address

6650 RIVERS AVE STE 105
NORTH CHARLESTON SC
29406-4829
US

V. Phone/Fax

Practice location:
  • Phone: 843-730-3901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: