Provider Demographics
NPI:1144270810
Name:MATTHEWS, SHIRNETT MAY (MD)
Entity type:Individual
Prefix:
First Name:SHIRNETT
Middle Name:MAY
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6303
Mailing Address - Fax:
Practice Address - Street 1:900 W FARIS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4255
Practice Address - Country:US
Practice Address - Phone:864-679-3900
Practice Address - Fax:864-679-3901
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC320672085R0001X
NJMA 080367002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2742861000OtherAMERIHEALTH - NJOS #
NJP00416963OtherRAILROAD MEDICARE
NJ1592771OtherCIGNA PROVIDER #
NJ3K4198OtherHEALTH NET PROVIDER #
NJP00613891OtherRAILROAD MEDICARE PTAN
SC320672Medicaid
NJ0100790Medicaid
NJ316663OtherAMERIGROUP PROVIDER #
NJ316663OtherAMERIGROUP PROVIDER #
NJ2742861000OtherAMERIHEALTH - NJOS #
NJ1592771OtherCIGNA PROVIDER #
SCAA41987951Medicare PIN
NJ0100790Medicaid