Healthcare Provider Details

I. General information

NPI: 1649766437
Provider Name (Legal Business Name): SHANDREA FOSTER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK RD STE 103
COLUMBIA SC
29203-6517
US

IV. Provider business mailing address

2 MEDICAL PARK RD STE 103
COLUMBIA SC
29203-6517
US

V. Phone/Fax

Practice location:
  • Phone: 803-545-5768
  • Fax: 803-434-4596
Mailing address:
  • Phone: 803-545-5768
  • Fax: 803-434-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: