Healthcare Provider Details

I. General information

NPI: 1982625745
Provider Name (Legal Business Name): PAUL ANDREW EVANGELISTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N SUMTER ST SUITE 400
SUMTER SC
29150-4916
US

IV. Provider business mailing address

100 N SUMTER ST SUITE 400
SUMTER SC
29150-4916
US

V. Phone/Fax

Practice location:
  • Phone: 839-200-7205
  • Fax: 803-778-5403
Mailing address:
  • Phone: 839-200-7205
  • Fax: 803-778-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number22833
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number22833
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number22833
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: