Healthcare Provider Details

I. General information

NPI: 1437160710
Provider Name (Legal Business Name): BIOSERENITY USA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 COLUMBIANA DR 100
COLUMBIA SC
29212
US

IV. Provider business mailing address

99 ROSEWOOD DR STE 245
DANVERS MA
01923-4537
US

V. Phone/Fax

Practice location:
  • Phone: 803-749-3599
  • Fax:
Mailing address:
  • Phone: 978-536-7400
  • Fax: 978-535-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANICE SHOCK
Title or Position: EVP CLINICAL OPERATIONS
Credential:
Phone: 214-532-3757