Healthcare Provider Details

I. General information

NPI: 1154079515
Provider Name (Legal Business Name): SHAYLEEN SAMMONS LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 OFFICE PARK CT
COLUMBIA SC
29223-5954
US

IV. Provider business mailing address

131 GOLDEN OAK DR
LEXINGTON SC
29072-6959
US

V. Phone/Fax

Practice location:
  • Phone: 803-760-6828
  • Fax:
Mailing address:
  • Phone: 803-760-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLMW-0107
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: