Provider Demographics
NPI:1033341599
Name:SHAYNE, BONNIE N
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:N
Last Name:SHAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:N
Other - Last Name:SHAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:200 MCGEE RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2104
Mailing Address - Country:US
Mailing Address - Phone:864-260-2221
Mailing Address - Fax:864-260-2225
Practice Address - Street 1:200 MCGEE RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-2104
Practice Address - Country:US
Practice Address - Phone:864-260-2221
Practice Address - Fax:864-260-2225
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1508814625Medicaid
SC3340Medicare PIN