Provider Demographics
NPI:1780914051
Name:GAINEY, SHANNON LINDSEY (FNP)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LINDSEY
Last Name:GAINEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LINDSEY
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3955 FABER PLACE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8578
Mailing Address - Country:US
Mailing Address - Phone:843-207-1760
Mailing Address - Fax:843-207-1727
Practice Address - Street 1:3955 FABER PLACE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8578
Practice Address - Country:US
Practice Address - Phone:843-207-1760
Practice Address - Fax:843-207-1727
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00820366OtherRAILROAD MEDICARE-RSFPN
SCNP1548Medicaid
SCAA48059223Medicare PIN