Provider Demographics
NPI:1477271492
Name:SCARBOROUGH, REEVA
Entity Type:Individual
Prefix:
First Name:REEVA
Middle Name:
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BROAD ST STE 11028
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1902
Mailing Address - Country:US
Mailing Address - Phone:803-607-3197
Mailing Address - Fax:
Practice Address - Street 1:1375 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-9206
Practice Address - Country:US
Practice Address - Phone:803-607-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company