Provider Demographics
NPI:1154505006
Name:FORSYTH, ANGELYN MELODY (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANGELYN
Middle Name:MELODY
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8673 HICKORY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-6871
Mailing Address - Country:US
Mailing Address - Phone:843-318-0345
Mailing Address - Fax:843-494-9644
Practice Address - Street 1:302A MIDLAND PKWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8102
Practice Address - Country:US
Practice Address - Phone:843-318-0345
Practice Address - Fax:843-494-9644
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL145171100000X
SC145171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist