Healthcare Provider Details

I. General information

NPI: 1295092328
Provider Name (Legal Business Name): SUZANNE M O'SHEA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W. HILL BLVD
CHARLESTON SC
29404-0000
US

IV. Provider business mailing address

4008 PLANTATION HOUSE RD
SUMMERVILLE SC
29485-6239
US

V. Phone/Fax

Practice location:
  • Phone: 843-963-6994
  • Fax: 843-963-6543
Mailing address:
  • Phone: 843-963-6994
  • Fax: 843-963-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number77629
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: