Healthcare Provider Details

I. General information

NPI: 1568376762
Provider Name (Legal Business Name): LINDSAY AMAYA DESHIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BROAD ST
CAMDEN SC
29020-4756
US

IV. Provider business mailing address

811 POLO RD APT 233
COLUMBIA SC
29223-4424
US

V. Phone/Fax

Practice location:
  • Phone: 803-272-4445
  • Fax:
Mailing address:
  • Phone: 803-553-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9917
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: