Basic Information
| Provider Information | |||||||||
| NPI: | 1447204938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAWINSKY | ||||||||
| FirstName: | ARLENE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROSENTHAL | ||||||||
| OtherFirstName: | ARLENE | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 776 DANIEL ELLIS DR | ||||||||
| Address2: | BLDG 2 STE A | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294123094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437958100 | ||||||||
| FaxNumber: | 8435732534 | ||||||||
| Practice Location | |||||||||
| Address1: | 776 DANIEL ELLIS DR | ||||||||
| Address2: | BLDG 2 STE A | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294123094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437958100 | ||||||||
| FaxNumber: | 8435732534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 11/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 18048 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 180486 | 05 | SC | MEDICAID |