Healthcare Provider Details

I. General information

NPI: 1689243115
Provider Name (Legal Business Name): KELLI E SHAPIRO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9565 HIGHWAY 78 BLDG 700
LADSON SC
29456-4116
US

IV. Provider business mailing address

9565 HIGHWAY 78 BLDG 102
LADSON SC
29456-4118
US

V. Phone/Fax

Practice location:
  • Phone: 843-569-4546
  • Fax:
Mailing address:
  • Phone: 843-569-4546
  • Fax: 843-569-4535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7689
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: