Provider Demographics
NPI:1740036938
Name:SARMIENTO, MA MELISSA REYES
Entity type:Individual
Prefix:
First Name:MA MELISSA
Middle Name:REYES
Last Name:SARMIENTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:REYES
Other - Last Name:SARMIENTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:2725 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6498
Mailing Address - Country:US
Mailing Address - Phone:843-617-1294
Mailing Address - Fax:
Practice Address - Street 1:2725 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6498
Practice Address - Country:US
Practice Address - Phone:843-617-1294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28665363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health