Individual
FANNY SARAH ALIE-CUSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
111 W GROVER ST, SHELBY, NC 28150-3824
(980) 487-1900
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2023-02260
NC
2086S0129X
Vascular Surgery Physician
Primary
2023-02260
NC
Other
Enumeration date
07/05/2018
Last updated
07/15/2024
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