Provider Demographics
NPI:1710564885
Name:CARMIGNANI, SHANNON MCAVOY (DPM)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MCAVOY
Last Name:CARMIGNANI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 SUMTER HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4948
Mailing Address - Country:US
Mailing Address - Phone:203-312-3798
Mailing Address - Fax:
Practice Address - Street 1:208 E 2ND NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-2157
Practice Address - Country:US
Practice Address - Phone:843-904-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC762213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist