Provider Demographics
NPI:1497819221
Name:DALEY, LEIGH WATROBSKI (PA)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:WATROBSKI
Last Name:DALEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:KRISITN
Other - Last Name:WATROBSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:180 WINGO WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-884-0302
Practice Address - Fax:843-849-9308
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1540363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1305PAMedicaid
SC1305PAMedicaid