Healthcare Provider Details

I. General information

NPI: 1861864431
Provider Name (Legal Business Name): STEFANIE ANN MAUNEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8740 RIVERS AVE
NORTH CHARLESTON SC
29406-9211
US

IV. Provider business mailing address

2880 TRICOM ST
NORTH CHARLESTON SC
29406-9171
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-5990
  • Fax:
Mailing address:
  • Phone: 843-797-5050
  • Fax: 843-797-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2434
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2434
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: