Healthcare Provider Details

I. General information

NPI: 1427952761
Provider Name (Legal Business Name): LASHEDA CHANTEL COKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 DIBERT ST
SUMTER SC
29153-2012
US

IV. Provider business mailing address

1045 DIBERT ST
SUMTER SC
29153-2012
US

V. Phone/Fax

Practice location:
  • Phone: 803-834-0579
  • Fax:
Mailing address:
  • Phone: 803-834-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number011604376
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: