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NPI Code Detail

MEDICARE: ASHLEY NICOLE STARODUB PA

MEDICARE: ASHLEY NICOLE STARODUB PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant2226SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588054092
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY NICOLE STARODUB PA
Provider Business Mailing Address
First Line : PO BOX 751649
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1649
Country : US
Telephone Number : 843-789-1620
Fax Number : 843-724-2440
Provider Business Practice Location Address
First Line : 3885 W ASHLEY CIR STE F600
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-9273
Country : US
Telephone Number : 843-402-1360
Fax Number : 843-402-3309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2015
Last Update Date : 08/19/2021

Similar Medicare Providers

1720665276 — MRS. ELIZABETH DANIELLE BUTLER FNP
Practice Location Address:
3885 W ASHLEY CIR # F600
CHARLESTON, SC
29414-9273
Practice Phone: 843-402-1360
Practice Fax: 843-402-3309
1861440323 — MS. TERESA LYNN HERRING P.A.
Practice Location Address:
3885 W ASHLEY CIR STE F600
CHARLESTON, SC
29414-9273
Practice Phone: 843-402-1360
Practice Fax: 843-402-3309
1467774042 — MRS. SAMURDHI JAYAWEERA ROBERTS PA-C
Practice Location Address:
3885 W ASHLEY CIR STE F600
CHARLESTON, SC
29414-9273
Practice Phone: 843-402-1360
Practice Fax:
1194181693 — ELIZABETH BILANCIONE APRN, FNP
Practice Location Address:
3885 W ASHLEY CIR # F600
CHARLESTON, SC
29414-9273
Practice Phone: 843-402-1360
Practice Fax: 843-402-3309
1346732526 — CHRISTINA REYNOLDS BREUNSBACH PA
Practice Location Address:
3885 W ASHLEY CIR STE F600
CHARLESTON, SC
29414-9273
Practice Phone: 843-402-1360
Practice Fax: 843-402-3309
1073090965 — KORI A. BORNEMAN FNP
Practice Location Address:
3885 W ASHLEY CIR STE F600
CHARLESTON, SC
29414-9273
Practice Phone: 843-402-1360
Practice Fax: 843-402-3309

Directions to “ ASHLEY NICOLE STARODUB PA” Practice Location

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