Individual
SHAWN STEPHENS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
146 E HOSPITAL DR STE 140, WEST COLUMBIA, SC 29169-4800
(803) 936-7076
(803) 936-7925
Mailing address
1333 TAYLOR ST STE 1C, COLUMBIA, SC 29201-2944
(803) 254-6391
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
1356984751
SC
363A00000X
Physician Assistant
Primary
3641
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/18/2019
Last updated
03/18/2026
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