Active NPI
Stacy Nicole Sherbutt, RDH
- Dental Hygienist
- Goose Creek, SC
National Provider Identifier
1780246553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 11330
- Practice address
- Naval Weapons Statiom
316 Red Bank Rd
Goose Creek, SC 29466 - Phone
- (843) 794-4508
- NPI assigned
- Jul 2, 2019
- Last updated
- Jul 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 11330 | SC | Primary |
Addresses
Primary practice location
Naval Weapons Statiom
316 Red Bank Rd
Goose Creek, SC 29466
Mailing address
2170 Snyder Cir Apt 213
Mount Pleasant, SC 29466-7818
Phone (810) 300-4487
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11330 | SC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562025600000",
"number": "1780246553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2170 SNYDER CIR APT 213",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294667818",
"telephone_number": "810-300-4487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NAVAL WEAPONS STATIOM",
"address_2": "316 RED BANK RD",
"city": "GOOSE CREEK",
"state": "SC",
"postal_code": "29466",
"telephone_number": "843-794-4508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHERBUTT",
"first_name": "STACY",
"middle_name": "NICOLE",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-02",
"last_updated": "2019-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "SC",
"license": "11330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goose Creek, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.