Healthcare Provider Details

I. General information

NPI: 1528688249
Provider Name (Legal Business Name): MADYSON SHEA RIDDELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CHEVES ST STE 260
FLORENCE SC
29506-2652
US

IV. Provider business mailing address

800 E CHEVES ST STE 260
FLORENCE SC
29506-2652
US

V. Phone/Fax

Practice location:
  • Phone: 843-665-7941
  • Fax: 843-665-1257
Mailing address:
  • Phone: 843-665-7941
  • Fax: 843-665-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number97200
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101028613
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: