Provider Demographics
NPI:1477262145
Name:MCNEAL, TROYDENIUS
Entity Type:Individual
Prefix:
First Name:TROYDENIUS
Middle Name:
Last Name:MCNEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 VICTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:SC
Mailing Address - Zip Code:29112-8117
Mailing Address - Country:US
Mailing Address - Phone:803-673-6719
Mailing Address - Fax:
Practice Address - Street 1:133 VICTORIA CIR
Practice Address - Street 2:
Practice Address - City:NORTH
Practice Address - State:SC
Practice Address - Zip Code:29112-8117
Practice Address - Country:US
Practice Address - Phone:803-673-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC92-1028039Medicaid