Shakelia Stephens
Individual provider Active NPI Contractor · Georgetown, SC
NPI 1972045078 · NPPES record last updated Nov 7, 2016
Key facts
- NPI
- 1972045078
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 178904 (SC)
- Practice address
- 4025 N Fraser St
Georgetown, SC 29440-6659 - Phone
- (843) 372-7304
- NPI assigned
- Nov 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178904 | SC | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 178904 | SC | Yes |
Addresses
Primary practice location
4025 N Fraser St
Georgetown, SC 29440-6659
Mailing address
4025 N Fraser St
Georgetown, SC 29440-6659
Other providers in Georgetown, SC
- Elizabeth St. Laurent
- Sarah Stamper
- State of South Carolina
- Michelle M Steffen
- Sandra L Steiner
- Dusty Stokes
- Angela Stork
- John M Stover Jr.
- Michael Patrick Stribos
- Susangeline Schmidt Strickland
All providers in Georgetown, SC · Contractor in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.