Provider Demographics
NPI:1578019717
Name:SHAHEEN, JULIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:WIKIERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5401 NETHERBY LN STE 1202
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7365
Mailing Address - Country:US
Mailing Address - Phone:843-872-3015
Mailing Address - Fax:
Practice Address - Street 1:5401 NETHERBY LN STE 1202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7365
Practice Address - Country:US
Practice Address - Phone:843-872-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004740RX363A00000X
SC3550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant