Healthcare Provider Details

I. General information

NPI: 1902750805
Provider Name (Legal Business Name): MADISON SCIMANICO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6282
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: