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General NPI Number Information
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NPI Number | 1710564885
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Entity Type | Individual
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Provider Name | SHANNON MCAVOY CARMIGNANI DPM
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Gender | Female
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 208 E 2ND NORTH ST
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City | SUMMERVILLE
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State | SC
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Zip | 29483-2157
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Country | US
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Telephone | 843-904-5061
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Fax |
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Provider Business Mailing Address
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Address Line | 972 SUMTER HWY
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City | KINGSTREE
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State | SC
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Zip | 29556-4948
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Country | US
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Telephone | 203-312-3798
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 762
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License Number State | SC
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