NPI 1528309606

Portereshice Shunta Brabham

Practitioner Health Maintenance Organization Fairfax, SC

Practice location

Address: 345 Amelia St, Fairfax, SC 29827-5967
Phone: (803) 682-7110

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X

Other Health Maintenance Organization providers in South Carolina →

Registry record

NPI: 1528309606
Entity type: Individual
Sex (as registered): Female
NPI issued: 14 Mar 2013
Record last updated: 14 Mar 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.