Healthcare Provider Details

I. General information

NPI: 1629967617
Provider Name (Legal Business Name): UNIQA SADE ROBERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

7358 GARNERS FERRY RD STE 126
COLUMBIA SC
29209-2198
US

IV. Provider business mailing address

7358 GARNERS FERRY RD STE 126
COLUMBIA SC
29209-2198
US

V. Phone/Fax

Practice location:
  • Phone: 803-661-6877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number250112
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: