Provider Demographics
NPI:1255126314
Name:MANAIZA, SHANEISE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SHANEISE
Middle Name:
Last Name:MANAIZA
Suffix:
Gender:
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 DEEP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-5705
Mailing Address - Country:US
Mailing Address - Phone:803-521-6180
Mailing Address - Fax:
Practice Address - Street 1:630 PROMENADE PL
Practice Address - Street 2:SUITE 17 SUITE 407
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229
Practice Address - Country:US
Practice Address - Phone:803-704-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13683225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist