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General NPI Number Information
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NPI Number | 1538125315
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Entity Type | Individual
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Provider Name | SHERRY JANE FAMORCA VIDUYA MD
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Gender | Female
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 110 SPRINGHALL DR STE A
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City | GOOSE CREEK
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State | SC
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Zip | 29445-5335
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Country | US
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Telephone | 843-973-8503
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Fax | 843-990-5068
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Provider Business Mailing Address
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Address Line | PO BOX 13955
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City | CHARLESTON
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State | SC
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Zip | 29422-3955
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Country | US
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Telephone | 843-779-6444
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Fax | 843-779-6438
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19583
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License Number State | SC
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