Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101048009 | VA |
N | 208000000X | Pediatrician | 83712 | SC |
N | 208000000X | Pediatrician | CA-G160210 | CA |
N | 2080P0205X | Pediatric Endocrinologist | 0101048009 | VA |
Y | 2080P0205X | Pediatric Endocrinologist | 83712 | SC |
N | 2080P0205X | Pediatric Endocrinologist | CA-G160210 | CA |
NPI | 1225132665 |
---|---|
Provider Name | Dr. Deidre L. Mcsweeney - Tyson |
First Address | Florence, SC 29506-2769 |
Second Address | Florence, SC 29506-2769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 26/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6720358 | (05) | VA |
F76932 | (02) |