Provider Demographics
NPI:1073229852
Name:SCOTT, DEDREANNA
Entity Type:Individual
Prefix:
First Name:DEDREANNA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 ASHLEY RIVER RD APT 1205
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4786
Mailing Address - Country:US
Mailing Address - Phone:910-977-1868
Mailing Address - Fax:
Practice Address - Street 1:1871 ASHLEY RIVER RD APT 1205
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4786
Practice Address - Country:US
Practice Address - Phone:910-977-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program