Individual
SHAMONIQUE FAVOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
206 GINGEROOT WAY, COLUMBIA, SC 29203-6783
(803) 238-1640
Mailing address
206 GINGEROOT WAY, COLUMBIA, SC 29203-6783
(803) 238-1640
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
9986560
SC
251J00000X
Nursing Care Agency
53966
SC
251J00000X
Nursing Care Agency
9986560
SC
Other
Enumeration date
08/03/2021
Last updated
08/03/2021
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