Healthcare Provider Details

I. General information

NPI: 1255261889
Provider Name (Legal Business Name): CRYSTAL SHEHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

535 LINGER LONGER DR UNIT 5109
JOHNS ISLAND SC
29455-3297
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-5011
  • Fax:
Mailing address:
  • Phone: 980-200-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number553900
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: