Healthcare Provider Details

I. General information

NPI: 1467007252
Provider Name (Legal Business Name): SHANAY BURCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W HIGHWAY 378
GRESHAM SC
29546-4080
US

IV. Provider business mailing address

1802 W HIGHWAY 378
GRESHAM SC
29546-4080
US

V. Phone/Fax

Practice location:
  • Phone: 843-496-5223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: