Provider Demographics
NPI:1720219728
Name:SULEWSKI, ANDREA LEE (ATC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:SULEWSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 AUGUSTA PLANTATION DR
Mailing Address - Street 2:UNIT W
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6449
Mailing Address - Country:US
Mailing Address - Phone:773-680-0104
Mailing Address - Fax:
Practice Address - Street 1:3302 ROBERT GRISSOM PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6401
Practice Address - Country:US
Practice Address - Phone:843-445-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer