Healthcare Provider Details

I. General information

NPI: 1902614035
Provider Name (Legal Business Name): SHANNON ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 RAPIDS CT
COLUMBIA SC
29212-3037
US

IV. Provider business mailing address

320 RAPIDS CT
COLUMBIA SC
29212-3037
US

V. Phone/Fax

Practice location:
  • Phone: 803-440-9973
  • Fax:
Mailing address:
  • Phone: 803-440-9973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number240556
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: