Healthcare Provider Details

I. General information

NPI: 1104720671
Provider Name (Legal Business Name): SHERIA AMANUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 ASHLEY RIVER RD STE B2
CHARLESTON SC
29407-4782
US

IV. Provider business mailing address

48 ABDULLAH LN
SEABROOK SC
29940-3664
US

V. Phone/Fax

Practice location:
  • Phone: 803-833-9060
  • Fax:
Mailing address:
  • Phone: 803-833-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number10036745
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: