Provider Demographics
NPI:1205942943
Name:HO, SHIRLEY L (PA)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:L
Last Name:HO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118008
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8008
Mailing Address - Country:US
Mailing Address - Phone:843-554-8312
Mailing Address - Fax:843-554-5141
Practice Address - Street 1:435 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6407
Practice Address - Country:US
Practice Address - Phone:843-873-1592
Practice Address - Fax:843-871-2936
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00801707OtherRAIL ROAD PIN
SC0443PAMedicaid
SCGP3566OtherMEDICAID GROUP #
SCGP3566OtherMEDICAID GROUP #
SCAA14745281Medicare PIN
SCAA14745277Medicare PIN
SCAA14746868Medicare PIN
SCQ70944Medicare UPIN
SCAA14748798Medicare PIN
SCAA14746882Medicare PIN
SCAA14747126Medicare PIN
SCAA14747499Medicare PIN
SCAA14745282Medicare PIN
SC0443PAMedicaid
SCAA14747006Medicare PIN
SCAA14747522Medicare PIN
SCAA14747555Medicare PIN
SCAA14747819Medicare PIN