Individual
VALERIE MALVERN-BRANDT SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
14 RICHLAND MEDICAL PARK DR, SUITE 200, COLUMBIA, SC 29203-6877
(803) 296-9200
(803) 296-9297
Mailing address
PO BOX 22265, BELFAST, ME 04915-4473
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
0110002597
VA
363AS0400X
Surgical Physician Assistant
Primary
2550
SC
363AS0400X
Surgical Physician Assistant
MA056652
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083852370
MEDICARE
VA
05
—
1083852370
—
VA
05
—
2832PA
—
SC
Enumeration date
01/26/2009
Last updated
03/09/2018
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