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General NPI Number Information
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NPI Number | 1962055632
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Entity Type | Individual
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Provider Name | MAZIE SUNSHINE UNDERWOOD MS, ATC, CSCS
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 1951 CLEMENTS FERRY RD
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City | CHARLESTON
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State | SC
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Zip | 29492-8322
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Country | US
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Telephone | 843-797-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 1951 CLEMENTS FERRY RD
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City | CHARLESTON
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State | SC
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Zip | 29492-8322
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Country | US
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Telephone | 843-797-5050
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Fax | 843-797-3633
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1906
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License Number State | SC
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