Provider Demographics
NPI:1003873894
Name:RILEY, SHAWN F (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:F
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3781 HOPSEWEE DR
Mailing Address - Street 2:PLANTATION POINT
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577
Mailing Address - Country:US
Mailing Address - Phone:843-444-9224
Mailing Address - Fax:
Practice Address - Street 1:1115 48TH AVE N
Practice Address - Street 2:SUITE 121
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-449-6478
Practice Address - Fax:843-497-8571
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC17005207W00000X
NC9300575207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF43253Medicare UPIN
NC2337591Medicare PIN