Healthcare Provider Details

I. General information

NPI: 1679345011
Provider Name (Legal Business Name): KANESHIA SADE' GAY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 WOODSIDE EXECUTIVE CT
AIKEN SC
29803-3822
US

IV. Provider business mailing address

929 GREENVILLE CIR
COLUMBIA SC
29210-7924
US

V. Phone/Fax

Practice location:
  • Phone: 706-627-6005
  • Fax:
Mailing address:
  • Phone: 803-369-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6691
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: