Healthcare Provider Details

I. General information

NPI: 1154846301
Provider Name (Legal Business Name): MICHELLE INEZ SHANKLAND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE INEZ PORTER

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 UNIVERSITY BLVD STE 300
NORTH CHARLESTON SC
29406-9889
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-606-7174
  • Fax: 843-606-8122
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4079
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: