Provider Demographics
NPI:1447091715
Name:GAFFNEY, SHATANNA NICOLA
Entity type:Individual
Prefix:
First Name:SHATANNA
Middle Name:NICOLA
Last Name:GAFFNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 BOYER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29059-9238
Mailing Address - Country:US
Mailing Address - Phone:843-312-2381
Mailing Address - Fax:
Practice Address - Street 1:3300 W MONTAGUE AVE STE 218
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-7916
Practice Address - Country:US
Practice Address - Phone:843-321-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-1994374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide