Provider Demographics
NPI:1255800223
Name:BERLEY, SHANNON BECKHAM (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:BECKHAM
Last Name:BERLEY
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 1:1829 NANCE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2553
Mailing Address - Country:US
Mailing Address - Phone:803-321-2670
Mailing Address - Fax:803-321-2671
Practice Address - Street 1:1829 NANCE ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2553
Practice Address - Country:US
Practice Address - Phone:803-321-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC244603163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse