Healthcare Provider Details

I. General information

NPI: 1720275266
Provider Name (Legal Business Name): CHERYL LORI ZEIDMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 04/28/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5046 HIGHWAY 17 BYP S STE 200
MYRTLE BEACH SC
29588-4503
US

IV. Provider business mailing address

1775 TIMMONS ST
MT PLEASANT SC
29466-7598
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-0453
  • Fax: 843-449-9531
Mailing address:
  • Phone: 954-214-8960
  • Fax: 843-449-9531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3887
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: