Provider Demographics
NPI:1154166270
Name:BREAKWATER CENTER FOR DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
Entity type:Organization
Organization Name:BREAKWATER CENTER FOR DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-708-0264
Mailing Address - Street 1:3019 ALLISON COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4971
Mailing Address - Country:US
Mailing Address - Phone:843-708-0264
Mailing Address - Fax:
Practice Address - Street 1:494B SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7275
Practice Address - Country:US
Practice Address - Phone:843-259-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities