Provider Demographics
NPI:1194371500
Name:PRABHAKAR, SHAVON CHAMERI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAVON
Middle Name:CHAMERI
Last Name:PRABHAKAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LAURELHURST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3825
Mailing Address - Country:US
Mailing Address - Phone:803-260-7719
Mailing Address - Fax:844-309-7454
Practice Address - Street 1:169 LAURELHURST AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3825
Practice Address - Country:US
Practice Address - Phone:803-730-0742
Practice Address - Fax:844-309-7454
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23157363LF0000X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health