Provider Demographics
NPI:1346026903
Name:SESCILLA, LOGAN BROOKS (PA-C)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:BROOKS
Last Name:SESCILLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32785
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2785
Mailing Address - Country:US
Mailing Address - Phone:919-633-3911
Mailing Address - Fax:919-663-3011
Practice Address - Street 1:101 WALMART SUPERCENTER
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-6755
Practice Address - Country:US
Practice Address - Phone:919-633-3911
Practice Address - Fax:919-663-3011
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant