Healthcare Provider Details

I. General information

NPI: 1124966890
Provider Name (Legal Business Name): SHANNON MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 HERLONG AVE S
ROCK HILL SC
29732-1670
US

IV. Provider business mailing address

223 HERLONG AVE S
ROCK HILL SC
29732-1670
US

V. Phone/Fax

Practice location:
  • Phone: 803-328-2625
  • Fax: 803-328-1408
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC74382
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: