Healthcare Provider Details

I. General information

NPI: 1306523766
Provider Name (Legal Business Name): STELLA SHIFRIN-TATESURE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 01/18/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 SAVAGE RD STE 100E
CHARLESTON SC
29407-4788
US

IV. Provider business mailing address

1941 SAVAGE RD STE 100E
CHARLESTON SC
29407-4788
US

V. Phone/Fax

Practice location:
  • Phone: 843-793-1353
  • Fax: 843-818-4172
Mailing address:
  • Phone: 843-793-1353
  • Fax: 843-818-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27498
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: