MEDICARE: SHAYLYNN KING WAGNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	6338	SC

General Provider Information

NPI Number	:	1568989499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYLYNN KING WAGNER

Provider Business Mailing Address
First Line	:	269 TORSLANDA LN
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-7042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 TORSLANDA LN
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-7042
Country	:	US
Telephone Number	:	843-900-1345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	03/27/2025

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Directions to “ SHAYLYNN KING WAGNER ” Practice Location

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