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Individual

MICHELLE L. DEENEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
823 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 449-1010
(843) 497-6171
Mailing address
PO BOX 421718, ATTN: PAYER CONTRACTING & RELATIONS, GEORGETOWN, SC 29442-4203
(843) 527-7000

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00248200
NJ
363A00000X
Physician Assistant
Primary
TL2265
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1079413
WELLCARE
SC
05
1366744989
NC
05
2101PA
SC
01
3674348
UNITED
SC
01
9987966
AETNA
SC
01
P01491958
RAILROAD MEDICARE
SC
Enumeration date
12/02/2010
Last updated
12/03/2025
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