Healthcare Provider Details

I. General information

NPI: 1497498380
Provider Name (Legal Business Name): ANESHIA D ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 CODY ST
COLUMBIA SC
29203-6314
US

IV. Provider business mailing address

1726 CODY ST
COLUMBIA SC
29203-6314
US

V. Phone/Fax

Practice location:
  • Phone: 803-210-6941
  • Fax:
Mailing address:
  • Phone: 803-210-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberRC68795
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: