Provider Demographics
NPI:1639664766
Name:MILES, BREELYN NICOLE (DPM)
Entity Type:Individual
Prefix:MS
First Name:BREELYN
Middle Name:NICOLE
Last Name:MILES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 LADSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6444
Mailing Address - Country:US
Mailing Address - Phone:843-851-9069
Mailing Address - Fax:843-871-8248
Practice Address - Street 1:4340 LADSON RD STE C
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-6444
Practice Address - Country:US
Practice Address - Phone:843-851-9069
Practice Address - Fax:843-871-8248
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILPR00194213E00000X, 213ES0103X
SC721213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery