Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shane Wilburn, PA-C

Individual provider Physician Assistant · NPI 1669178075

Shane Wilburn, PA-C is a Physician Assistant in Summerville, South Carolina. Qualified in 2022, 4 years ago. Practices with Palmetto Primary Care Physicians LLC, a 148-clinician group and accepts Medicare assignment.

Years since qualifying
4
In the registry since
2023
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

89 Old Trolley Rd Ste 102
Summerville, SC 29485-4951
Phone: (854) 206-5513
Fax: (854) 246-8965
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1669178075
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedFebruary 7, 2023
Last updated in NPPESApril 22, 2025
Certification dateApril 22, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Palmetto Primary Care Physicians Llc — 148 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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