Kennedy, Shannon

Kennedy, Shannon is an individual health care provider with primary practice located at 109 Wappoo Creek Dr 2A, Charleston SC 29412-2135. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Kennedy, Shannon can be contacted via phone (843) 737-5206.

Contact Information

Primary practice address
109 Wappoo Creek Dr 2A Charleston SC 29412-2135
Phone: (843) 737-5206
Fax: (843) 795-7171
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 24910 South Carolina
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 249109 South Carolina

Profile Details

NPI number 1821022302
LBN Legal business name Kennedy, Shannon
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 10th, 2006
Last updated Feb 27th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821022302 NPPES
South Carolina MEDICAID 249109
South Carolina Other GP4841
South Carolina Other P00700010
South Carolina Other 5551

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