Provider Demographics
NPI:1477155968
Name:AMISTADE, SHAWNA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MARIE
Last Name:AMISTADE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 WAPPOO RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5861
Mailing Address - Country:US
Mailing Address - Phone:843-323-7534
Mailing Address - Fax:
Practice Address - Street 1:721 WAPPOO RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5861
Practice Address - Country:US
Practice Address - Phone:843-323-7534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC237988163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool