Healthcare Provider Details

I. General information

NPI: 1619901568
Provider Name (Legal Business Name): HEATHER ELIZABETH SHIFLETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 EDGEWATER CORPORATE PKWY STE 104
FORT MILL SC
29707-4526
US

IV. Provider business mailing address

8015 FARMBROOK DR
WAXHAW NC
28173-7123
US

V. Phone/Fax

Practice location:
  • Phone: 803-547-8660
  • Fax: 704-544-0172
Mailing address:
  • Phone: 704-667-2650
  • Fax: 704-544-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102370
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1328
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: