MEDICARE: AVERY LAUREN STEELAND

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
1	363A00000X	Physician Assistant	6051	SC
2	363A00000X	Physician Assistant
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1609630219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY LAUREN STEELAND

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	888-472-0043
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	2813 PARKERS LANDING RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-6743
Country	:	US
Telephone Number	:	248-499-0765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	01/15/2026

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