Provider Demographics
NPI:1528481355
Name:FOGGIE, SHARON NICOLE (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:NICOLE
Last Name:FOGGIE
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14009 HWY 221
Mailing Address - Street 2:
Mailing Address - City:ENOREE
Mailing Address - State:SC
Mailing Address - Zip Code:29335
Mailing Address - Country:US
Mailing Address - Phone:864-969-7070
Mailing Address - Fax:
Practice Address - Street 1:14009 HWY 221
Practice Address - Street 2:
Practice Address - City:ENOREE
Practice Address - State:SC
Practice Address - Zip Code:29335
Practice Address - Country:US
Practice Address - Phone:864-969-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRC177381744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management