Provider Demographics
NPI:1609154327
Name:FLEET, BRYAN STERLING (PA)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:STERLING
Last Name:FLEET
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 HICKLIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EDGEMOOR
Mailing Address - State:SC
Mailing Address - Zip Code:29712-7788
Mailing Address - Country:US
Mailing Address - Phone:803-328-9878
Mailing Address - Fax:
Practice Address - Street 1:800 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2202
Practice Address - Country:US
Practice Address - Phone:803-286-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant