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General NPI Number Information
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NPI Number | 1619901568
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Entity Type | Individual
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Provider Name | HEATHER ELIZABETH SHIFLETT PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 1040 EDGEWATER CORPORATE PKWY STE 104
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City | FORT MILL
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State | SC
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Zip | 29707-4526
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Country | US
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Telephone | 803-547-8660
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Fax | 704-544-0172
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Provider Business Mailing Address
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Address Line | 8015 FARMBROOK DR
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City | WAXHAW
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State | NC
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Zip | 28173-7123
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Country | US
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Telephone | 704-667-2650
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Fax | 704-544-0172
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1328
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 102370
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License Number State | NC
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