Healthcare Provider Details

I. General information

NPI: 1710917372
Provider Name (Legal Business Name): SHELLY DEANNE BRIGMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLY D. HOLSTRUM M.D.

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MONTICELLO RD BUILDING B STE.2
COLUMBIA SC
29203-4156
US

IV. Provider business mailing address

PO BOX 3788
COLUMBIA SC
29230-3788
US

V. Phone/Fax

Practice location:
  • Phone: 803-753-5590
  • Fax: 803-753-5592
Mailing address:
  • Phone: 803-733-5969
  • Fax: 803-753-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number23497
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: