Provider Demographics
NPI:1447878392
Name:SHUFORD, PATRICIA DENESE (RN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DENESE
Last Name:SHUFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 KINCAID BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-7116
Mailing Address - Country:US
Mailing Address - Phone:803-635-6481
Mailing Address - Fax:803-635-1410
Practice Address - Street 1:1136 KINCAID BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-7116
Practice Address - Country:US
Practice Address - Phone:803-635-6481
Practice Address - Fax:803-635-1410
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC250186163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse