Provider Demographics
NPI:1659022929
Name:SASSERMAN, HALEY MORGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MORGAN
Last Name:SASSERMAN
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 1:3295 KENSINGTON SQ SW
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-1921
Mailing Address - Country:US
Mailing Address - Phone:814-470-1329
Mailing Address - Fax:
Practice Address - Street 1:200 MIDDLEBURG DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3408
Practice Address - Country:US
Practice Address - Phone:843-903-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1185403OtherNCCPA CERTIFICATION NUMBER