Healthcare Provider Details

I. General information

NPI: 1548639008
Provider Name (Legal Business Name): ELIZABETH INGRAM SHANDS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 WADE HAMPTON BLVD STE 211
GREENVILLE SC
29609-4942
US

IV. Provider business mailing address

832 WADE HAMPTON BLVD STE 211
GREENVILLE SC
29609-4942
US

V. Phone/Fax

Practice location:
  • Phone: 864-735-6880
  • Fax:
Mailing address:
  • Phone: 864-735-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1364
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1364
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1364
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1364
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: