Provider Demographics
NPI:1083952683
Name:MOSES, SHEILA D
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:D
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 CENTRAL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:REMBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29128-9589
Mailing Address - Country:US
Mailing Address - Phone:803-428-3147
Mailing Address - Fax:803-428-3184
Practice Address - Street 1:55 CENTRAL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:REMBERT
Practice Address - State:SC
Practice Address - Zip Code:29128-9589
Practice Address - Country:US
Practice Address - Phone:803-428-3147
Practice Address - Fax:803-428-3184
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC77870163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse