Healthcare Provider Details

I. General information

NPI: 1528992104
Provider Name (Legal Business Name): DR. SEPIDEH MANAFI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 WEISS WAY
WAXHAW NC
28173-0800
US

IV. Provider business mailing address

10012 WEISS WAY
WAXHAW NC
28173-0800
US

V. Phone/Fax

Practice location:
  • Phone: 704-516-0084
  • Fax: 704-516-0084
Mailing address:
  • Phone: 704-516-0084
  • Fax: 704-516-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14666
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: