MEDICARE: SISTAGIRL MIDWIFERY

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	176B00000X	Midwife	0048	SC

General Provider Information

NPI Number	:	1497015135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SISTAGIRL MIDWIFERY

Provider Business Mailing Address
First Line	:	3956 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-7023
Country	:	US
Telephone Number	:	888-514-3055
Fax Number	:

Provider Business Practice Location Address
First Line	:	3956 RIVERS AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-7023
Country	:	US
Telephone Number	:	888-514-3055
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LICENSED MIDWIFE
Name	:	MRS. JAYVON DUPREE MUHAMMAD
Credential	:	CPM
Telephone Number	:	888-514-3055

Provider Enumeration Date	:	05/28/2012
Last Update Date	:	05/28/2012

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Directions to “SISTAGIRL MIDWIFERY ” Practice Location

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