Individual
DR. KELLY ELAINE SHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2687 LAKE PARK DR, NORTH CHARLESTON, SC 29406-9100
(843) 572-1010
(843) 569-1719
Mailing address
1300 HOSPITAL DR, MOUNT PLEASANT, SC 29464-3261
(843) 884-9646
(843) 884-9601
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
2008-02041
NC
208800000X
Urology Physician
LL28461
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
273905550
NC MED BOARD # 153519
NC
01
—
28461
SC MEDICAL LICENSE
SC
Enumeration date
10/23/2006
Last updated
02/17/2017
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