Healthcare Provider Details

I. General information

NPI: 1073213393
Provider Name (Legal Business Name): BRANDON SYKES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 FOWLER CT
MOUNT PLEASANT SC
29464-3570
US

IV. Provider business mailing address

958 FOWLER CT
MOUNT PLEASANT SC
29464-3570
US

V. Phone/Fax

Practice location:
  • Phone: 803-466-5362
  • Fax:
Mailing address:
  • Phone: 803-466-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number254666
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: