MEDICARE: IMAN SHARDEY SCOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1093563033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMAN SHARDEY SCOTT

Provider Business Mailing Address
First Line	:	716 ZIMALCREST DR APT 4004
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-6594
Country	:	US
Telephone Number	:	803-932-8627
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 ZIMALCREST DR APT 4004
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-6594
Country	:	US
Telephone Number	:	803-932-8627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	06/18/2026

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Directions to “ IMAN SHARDEY SCOTT ” Practice Location

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