Healthcare Provider Details

I. General information

NPI: 1255253951
Provider Name (Legal Business Name): SUNSET PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2379 AUGUSTA RD
WEST COLUMBIA SC
29169-4541
US

IV. Provider business mailing address

2379 AUGUSTA RD
WEST COLUMBIA SC
29169-4541
US

V. Phone/Fax

Practice location:
  • Phone: 803-794-4877
  • Fax: 803-794-4342
Mailing address:
  • Phone: 803-794-4877
  • Fax: 803-794-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SCOTTIE SHELLEY
Title or Position: OWNER
Credential:
Phone: 803-794-4877