Healthcare Provider Details

I. General information

NPI: 1376957837
Provider Name (Legal Business Name): SHANIKA DAMIEN RUTLEDGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 2ND AVE STE 101
SUMMERVILLE SC
29486-7889
US

IV. Provider business mailing address

PO BOX 602108
CHARLOTTE NC
28260-2108
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-2535
  • Fax: 843-573-2534
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37103
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: