Healthcare Provider Details

I. General information

NPI: 1174883128
Provider Name (Legal Business Name): ELIZABETH ANNE SHIRLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 PATEWOOD DR
GREENVILLE SC
29615-3570
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-1403
  • Fax: 864-455-3884
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34667
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: