Provider Demographics
NPI:1992530059
Name:GRAHAM, SHEKLA RENA
Entity type:Individual
Prefix:
First Name:SHEKLA
Middle Name:RENA
Last Name:GRAHAM
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 1:261 BROAD ST STE A1
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4146
Mailing Address - Country:US
Mailing Address - Phone:843-372-9727
Mailing Address - Fax:
Practice Address - Street 1:261 BROAD ST STE A1
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4146
Practice Address - Country:US
Practice Address - Phone:843-372-9727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide