Individual
CYNTHIA MAY FAGAN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 PATEWOOD DR STE B350, GREENVILLE, SC 29615-6337
(864) 454-4500
(864) 454-4505
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8617
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
24161
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP7057
—
SC
Enumeration date
08/10/2020
Last updated
04/11/2023
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