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General NPI Number Information
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NPI Number | 1912399742
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Entity Type | Individual
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Provider Name | SHANNON UYEDA ANP, BC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 04/03/2026
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Provider Practice Location Address
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Address Line | 2728 SUNSET BLVD SUITE 300
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4840
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Country | US
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Telephone | 803-479-8836
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Fax |
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Provider Business Mailing Address
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Address Line | 300 AGAPE DR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3307
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Country | US
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Telephone | 803-739-5282
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 19323
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License Number State | SC
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