Healthcare Provider Details

I. General information

NPI: 1174942734
Provider Name (Legal Business Name): SHANIQUA DAWN ALSTON MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST
MONCKS CORNER SC
29461-2673
US

IV. Provider business mailing address

210 PLEASANT HILL DR
GOOSE CREEK SC
29445-3595
US

V. Phone/Fax

Practice location:
  • Phone: 843-719-4600
  • Fax: 843-719-4778
Mailing address:
  • Phone: 843-224-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29450
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number219843
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number219843
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number219843
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: