Individual
MRS. THELISA Y SULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
201 COLUMBIA MALL BLVD STE 189, COLUMBIA, SC 29223-7550
(803) 602-5570
(888) 958-0279
Mailing address
201 COLUMBIA MALL BLVD STE 189, COLUMBIA, SC 29223-7550
(803) 602-5570
(888) 958-0279
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
2018-46169-45207
SC
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
2018-46169-45207
SC
332BC3200X
Customized Equipment (DME)
2018-46169-45207
SC
Other
Enumeration date
04/14/2018
Last updated
02/02/2020
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