Healthcare Provider Details

I. General information

NPI: 1124438759
Provider Name (Legal Business Name): SHANNON ELISABETH IRIZA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON DAVIS

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK RD STE 501
COLUMBIA SC
29203-6839
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-540-1000
  • Fax: 803-540-1011
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO034666
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number82202
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: