| Rupa Shetty Llc | |
|
237 Avenue Of The Palms Myrtle Beach SC 29579-1247 | |
| (843) 461-6133 | |
| (843) 234-6100 |
| Full Name | Rupa Shetty Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 237 Avenue Of The Palms, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Thomas L Ryba (MEMBER) |
| Authorized Official Contact | 8434616133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rupa Shetty Llc 237 Avenue Of The Palms Myrtle Beach SC 29579-1247 Ph: (843) 461-6133 | Rupa Shetty Llc 237 Avenue Of The Palms Myrtle Beach SC 29579-1247 Ph: (843) 461-6133 |
| NPI Number | 1205137817 |
|---|---|
| Provider Enumeration Date | 11/12/2010 |
| Last Update Date | 08/09/2011 |
| Medicare PECOS PAC ID | 7719166172 |
|---|---|
| Medicare Enrollment ID | O20110201000357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205137817 | NPI | - | NPPES |
| 3344 | Other | SC | WACCAMAW CENTER FOR MENTAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 27604 (South Carolina) | Primary |
| Provider Name | Rupa Shetty |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962428235 PECOS PAC ID: 8022064989 Enrollment ID: I20051130000256 |
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