Individual
FATIMA SHANI RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1294 LEISURE DR, SUMMERVILLE, SC 29486-2211
(973) 494-3128
Mailing address
1294 LEISURE DR, SUMMERVILLE, SC 29486-2211
(973) 494-3128
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
48745
SC
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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