Healthcare Provider Details

I. General information

NPI: 1730870676
Provider Name (Legal Business Name): CHEYANNA SAGE DU VERNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MEETING ST
CHARLESTON SC
29401-3153
US

IV. Provider business mailing address

41 WINTERGREEN DR
BEAUFORT SC
29906-8993
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 405-822-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-21-186649
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: