Individual
VICTORIA SHADIACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6193
(864) 560-1510
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
83156
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
831569
—
SC
01
—
SCJ2243365
MEDICARE PIN
SC
Enumeration date
04/06/2015
Last updated
03/25/2021
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