Healthcare Provider Details

I. General information

NPI: 1376345702
Provider Name (Legal Business Name): SHANNON FLAHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4731 HIGHWAY 17
MURRELLS INLET SC
29576-5127
US

IV. Provider business mailing address

4731 HIGHWAY 17
MURRELLS INLET SC
29576-5127
US

V. Phone/Fax

Practice location:
  • Phone: 843-839-7246
  • Fax:
Mailing address:
  • Phone: 843-839-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6418
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5799
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: