Healthcare Provider Details

I. General information

NPI: 1689597643
Provider Name (Legal Business Name): RAYNETTE MASHONDA PRIESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 WILEY AVE
YORK SC
29745-1849
US

IV. Provider business mailing address

226 WILEY AVE
YORK SC
29745-1849
US

V. Phone/Fax

Practice location:
  • Phone: 803-367-2408
  • Fax: 803-367-2408
Mailing address:
  • Phone: 803-367-2408
  • Fax: 803-367-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberL7M9A5Q8
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: