Provider Demographics
NPI:1619104981
Name:REAMS, ALICIA SHUTE (MD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:SHUTE
Last Name:REAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:C
Other - Last Name:SHUTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 23321
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-4321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2021 BRIDGEMILL DR STE 104
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-9211
Practice Address - Country:US
Practice Address - Phone:803-286-4676
Practice Address - Fax:803-289-6591
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01218207R00000X
SCLL31839207R00000X
SC31839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC318392Medicaid
NC1619104981Medicaid
SC318392Medicaid