Individual
GABRIELLA LEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1413 HIGHWAY 17 N, SURFSIDE BEACH, SC 29575-6012
(843) 238-5654
(843) 238-1624
Mailing address
300 SINGLETON RIDGE RD, ATTENTION PNS CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4618PA
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5986PA
—
SC
Enumeration date
09/19/2022
Last updated
03/20/2023
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