Individual
MRS. TAYO E HAIYEDE-SHITTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMSC, PA-C
Contact information
Practice address
5500 FRONT ST STE 240, SUMMERVILLE, SC 29486-8140
(843) 572-7727
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(843) 572-7727
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
011082
NY
363A00000X
Physician Assistant
Primary
1765
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1408PA
—
SC
Enumeration date
10/24/2006
Last updated
04/29/2024
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