Provider Demographics
NPI:1619699485
Name:MCCOY, SHANNON (CMA, CPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:CMA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531C OXFORD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-3333
Mailing Address - Country:US
Mailing Address - Phone:803-840-3379
Mailing Address - Fax:
Practice Address - Street 1:531C OXFORD ST STE 3
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3333
Practice Address - Country:US
Practice Address - Phone:803-840-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy