Provider Demographics
NPI:1679154306
Name:ELHOSARY, OMNAYA SAMIR
Entity Type:Individual
Prefix:
First Name:OMNAYA
Middle Name:SAMIR
Last Name:ELHOSARY
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 1:315 UNDERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7862
Mailing Address - Country:US
Mailing Address - Phone:803-357-8420
Mailing Address - Fax:
Practice Address - Street 1:222 RED BANK RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-4502
Practice Address - Country:US
Practice Address - Phone:843-628-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician