Healthcare Provider Details

I. General information

NPI: 1831953447
Provider Name (Legal Business Name): SERENE CHEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5090 TIMICUAN WAY, SUMMERVILLE, SC 29485
SUMMERVILLE SC
29485
US

IV. Provider business mailing address

1101 OLD TROLLEY RD STE 300
SUMMERVILLE SC
29485-5294
US

V. Phone/Fax

Practice location:
  • Phone: 843-810-0701
  • Fax:
Mailing address:
  • Phone: 843-376-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: