Provider Demographics
NPI:1710917372
Name:BRIGMAN, SHELLY DEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:DEANNE
Last Name:BRIGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHELLY
Other - Middle Name:D
Other - Last Name:HOLSTRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3788
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3788
Mailing Address - Country:US
Mailing Address - Phone:803-733-5969
Mailing Address - Fax:803-753-5591
Practice Address - Street 1:4605 MONTICELLO RD
Practice Address - Street 2:BUILDING B STE.2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-4156
Practice Address - Country:US
Practice Address - Phone:803-753-5590
Practice Address - Fax:803-753-5592
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC234972080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC234972Medicaid
SCH31288Medicare UPIN
SC045367Medicare PIN