Provider Demographics
NPI:1144984030
Name:MCFADDEN, FREDRICKA (HAIR REPLACEMENT SPE)
Entity type:Individual
Prefix:
First Name:FREDRICKA
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 S PIKE W
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2616
Mailing Address - Country:US
Mailing Address - Phone:803-773-9487
Mailing Address - Fax:
Practice Address - Street 1:556 S PIKE W
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2616
Practice Address - Country:US
Practice Address - Phone:803-773-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC99241744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management