Individual
SHANNON STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10125 DORCHESTER RD STE A7, SUMMERVILLE, SC 29485-8548
(843) 520-9934
Mailing address
144 BEN RUFUS DR, GEORGETOWN, SC 29440-8753
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
73192
SC
Other
Enumeration date
12/14/2020
Last updated
12/14/2020
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