Healthcare Provider Details

I. General information

NPI: 1942834676
Provider Name (Legal Business Name): SHA ROBINSON HAYNES REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 KATRINA CT
LEXINGTON SC
29073-6924
US

IV. Provider business mailing address

120 KATRINA CT
LEXINGTON SC
29073-6924
US

V. Phone/Fax

Practice location:
  • Phone: 803-605-2666
  • Fax: 803-356-5675
Mailing address:
  • Phone: 803-605-2666
  • Fax: 803-356-5675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number251579
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: