Healthcare Provider Details

I. General information

NPI: 1174013106
Provider Name (Legal Business Name): SHEA H STONE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 N GUIGNARD DR
SUMTER SC
29150-1519
US

IV. Provider business mailing address

215 N MAGNOLIA ST
SUMTER SC
29150-4943
US

V. Phone/Fax

Practice location:
  • Phone: 803-775-7898
  • Fax:
Mailing address:
  • Phone: 803-775-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95673
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: