Provider Demographics
NPI:1609106392
Name:GATES, SHALINI (CPNP)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 ROSINGS DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-7774
Mailing Address - Country:US
Mailing Address - Phone:843-875-4525
Mailing Address - Fax:
Practice Address - Street 1:1608 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3572
Practice Address - Country:US
Practice Address - Phone:843-248-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3933363LP0200X
IL209007780363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics