Healthcare Provider Details

I. General information

NPI: 1932570470
Provider Name (Legal Business Name): RYAN LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

823 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-1010
  • Fax: 843-497-6171
Mailing address:
  • Phone: 843-449-1010
  • Fax: 843-497-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3844
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: