Healthcare Provider Details

I. General information

NPI: 1053675819
Provider Name (Legal Business Name): SHEILA PUTMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEILA PARRISH DO

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 CIPRIANA DR STE 220
MYRTLE BEACH SC
29572-4621
US

IV. Provider business mailing address

1021 CIPRIANA DRIVE SUITE 220
MYRTLE BEACH SC
29572
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-6449
  • Fax:
Mailing address:
  • Phone: 843-449-6449
  • Fax: 843-449-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5101020060
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: