Individual
SHANNON BUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1101 OLD TROLLEY RD STE 300, SUMMERVILLE, SC 29485-5294
(843) 376-2670
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5250
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8121PA
—
SC
Enumeration date
06/13/2024
Last updated
07/21/2025
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