Individual
SHANIQUA ELIZABETH SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
232 HARPERS FERRY LN APT A5, SUMMERVILLE, SC 29486-8812
(843) 478-2123
Mailing address
232 HARPERS FERRY LN, SUMMERVILLE, SC 29486-8812
(843) 478-2123
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
121242577
SC
Other
Enumeration date
06/22/2021
Last updated
06/22/2021
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