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General NPI Number Information
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NPI Number | 1215490776
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Entity Type | Individual
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Provider Name | SHANNON MARIE PHILIPPS DO
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Gender | Female
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 1413 HIGHWAY 17 N
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City | SURFSIDE BEACH
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State | SC
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Zip | 29575-6012
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Country | US
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Telephone | 843-347-8041
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Fax | 843-347-8042
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Provider Business Mailing Address
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Address Line | 300 SINGLETON RIDGE RD ATTENTION CREDENTIALING
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City | CONWAY
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State | SC
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Zip | 29526-9142
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 93574
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License Number State | SC
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