Provider Demographics
NPI:1467271270
Name:ALLEN, ESTELLA YVONNE (RT(R))
Entity type:Individual
Prefix:
First Name:ESTELLA
Middle Name:YVONNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RT(R)
Other - Prefix:
Other - First Name:ESTELLA
Other - Middle Name:YVONNE
Other - Last Name:SMALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT(R)
Mailing Address - Street 1:9205 MARKLEYS GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8685
Mailing Address - Country:US
Mailing Address - Phone:843-441-0421
Mailing Address - Fax:
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-740-6030
Practice Address - Fax:843-579-3149
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14-15442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology