Healthcare Provider Details

I. General information

NPI: 1164454609
Provider Name (Legal Business Name): NAZILA ESHRAGHI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EXECUTIVE CT # 102
CLOVER SC
29710-9338
US

IV. Provider business mailing address

5 EXECUTIVE CT # 102
CLOVER SC
29710-9338
US

V. Phone/Fax

Practice location:
  • Phone: 803-693-2425
  • Fax: 833-989-2166
Mailing address:
  • Phone: 803-693-2425
  • Fax: 833-989-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4566
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number718
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: