Healthcare Provider Details

I. General information

NPI: 1295895977
Provider Name (Legal Business Name): SHELIA FANKHAUSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 HWY 17 BUS S
GARDEN CITY SC
29576-7611
US

IV. Provider business mailing address

2347 HWY 17 BUSINESS SOUTH
GARDEN CITY SC
29576-7611
US

V. Phone/Fax

Practice location:
  • Phone: 843-357-2443
  • Fax: 843-357-2132
Mailing address:
  • Phone: 843-357-2443
  • Fax: 843-357-2132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number12385
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: