Provider Demographics
NPI:1386182509
Name:ROUNDTREE, SHANNON D (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:ROUNDTREE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4124
Mailing Address - Country:US
Mailing Address - Phone:264-227-3600
Mailing Address - Fax:
Practice Address - Street 1:1736 MAIN ST S
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4124
Practice Address - Country:US
Practice Address - Phone:264-227-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse