Provider Demographics
NPI:1649766437
Name:FOSTER, SHANDREA (MS)
Entity Type:Individual
Prefix:
First Name:SHANDREA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL PARK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6517
Mailing Address - Country:US
Mailing Address - Phone:803-545-5768
Mailing Address - Fax:803-434-4596
Practice Address - Street 1:2 MEDICAL PARK RD STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6517
Practice Address - Country:US
Practice Address - Phone:803-545-5768
Practice Address - Fax:803-434-4596
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS