Provider Demographics
NPI:1912399742
Name:BURRELL, SHANNON UYEDA (ANP, BC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:UYEDA
Last Name:BURRELL
Suffix:
Gender:F
Credentials:ANP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 SUNSET BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4840
Mailing Address - Country:US
Mailing Address - Phone:803-479-8836
Mailing Address - Fax:
Practice Address - Street 1:2728 SUNSET BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4840
Practice Address - Country:US
Practice Address - Phone:803-479-8836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19323363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health