Provider Demographics
NPI:1962243782
Name:FIDDIE, HAYLEE
Entity type:Individual
Prefix:
First Name:HAYLEE
Middle Name:
Last Name:FIDDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FAIRCHILD ST STE 170
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7602
Mailing Address - Country:US
Mailing Address - Phone:803-339-1563
Mailing Address - Fax:
Practice Address - Street 1:115 FAIRCHILD ST STE 170
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7602
Practice Address - Country:US
Practice Address - Phone:803-339-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28808363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health