Healthcare Provider Details

I. General information

NPI: 1497148746
Provider Name (Legal Business Name): DARYA KABORDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 REGENCY RD APT H5
SPARTANBURG SC
29307-1800
US

IV. Provider business mailing address

300 REGENCY RD APT H5
SPARTANBURG SC
29307-1800
US

V. Phone/Fax

Practice location:
  • Phone: 734-476-0888
  • Fax:
Mailing address:
  • Phone: 734-476-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: