Provider Demographics
NPI:1801618962
Name:SOBERANIS, SHANA N (REFLEXOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:N
Last Name:SOBERANIS
Suffix:
Gender:F
Credentials:REFLEXOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 FAULKNER DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-8825
Mailing Address - Country:US
Mailing Address - Phone:864-497-6125
Mailing Address - Fax:
Practice Address - Street 1:2099 S PINE ST STE I
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-3349
Practice Address - Country:US
Practice Address - Phone:864-497-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant