Provider Demographics
NPI:1043754005
Name:DENDY, SYREETA (NP-C)
Entity type:Individual
Prefix:MS
First Name:SYREETA
Middle Name:
Last Name:DENDY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S LIBERTY ST APT 21
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3259
Mailing Address - Country:US
Mailing Address - Phone:864-753-1854
Mailing Address - Fax:
Practice Address - Street 1:244 WILD OLIVE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8179
Practice Address - Country:US
Practice Address - Phone:864-266-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-10
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN 20617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily